Tamauchi Satoshi, Kajiyama Hiroaki, Utsumi Fumi, Suzuki Shiro, Niimi Kaoru, Sakata Jun, Mizuno Mika, Shibata Kiyosumi, Kikkawa Fumitaka
Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Gynecologic Oncology, Aichi Cancer Center,, Nagoya, Japan.
J Obstet Gynaecol Res. 2018 Jan;44(1):151-156. doi: 10.1111/jog.13473. Epub 2017 Nov 9.
Medroxyprogesterone acetate (MPA) is used to preserve fertility in patients with Grade 1 endometrial cancer without myometrial invasion (G1EA) and those with atypical endometrial hyperplasia (AEH). However, the efficacy of retreatment with MPA has not been sufficiently established for patients who experience recurrence but wish to retain their fertility. This study aimed to show the effectiveness of MPA treatment and retreatment for AEH and G1EA.
A total of 39 patients received MPA treatment between 2005 and 2015, including nine with G1EA and 30 with AEH. The patients received high-dose (600 mg/day) MPA for 26 weeks. If a complete response was not achieved, MPA treatment was continued. After complete remission, if there was a recurrence, the patient was offered a choice of a hysterectomy or retreatment with MPA. The gynecologic and obstetric outcomes were retrospectively analyzed.
The median age was 34 years, and the median body mass index was 23.3 kg/m . The median follow-up period was 52 months. Complete response rates for the initial treatment were 89% for G1EA and 93% for AEH. Recurrence occurred in 88% of patients with G1EA (7/8) and 50% of those with AEH (14/28). Seven patients with G1EA and 11 with AEH received MPA retreatment, and 100% and 92% of these achieved a complete response. During the study period, a total of 14 pregnancies were recorded with 10 live births.
MPA can be effective for G1EA and AEH treatment even when they recur.
醋酸甲羟孕酮（MPA）用于保留无肌层浸润的1级子宫内膜癌（G1EA）患者及非典型子宫内膜增生（AEH）患者的生育能力。然而，对于复发但希望保留生育能力的患者，MPA再治疗的疗效尚未得到充分证实。本研究旨在表明MPA治疗及再治疗对AEH和G1EA的有效性。
2005年至2015年间共有39例患者接受了MPA治疗，其中9例为G1EA患者，30例为AEH患者。患者接受高剂量（600mg/天）MPA治疗26周。若未达到完全缓解，则继续MPA治疗。完全缓解后若复发，患者可选择子宫切除术或MPA再治疗。对妇产科结局进行回顾性分析。
中位年龄为34岁，中位体重指数为23.3kg/m 。中位随访期为52个月。G1EA初始治疗的完全缓解率为89%，AEH为93%。G1EA患者中有88%（7/8）复发，AEH患者中有50%（14/28）复发。7例G1EA患者和11例AEH患者接受了MPA再治疗，其中100%和92%达到了完全缓解。在研究期间，共记录到14次妊娠，其中10例活产。
即使G1EA和AEH复发，MPA治疗仍可能有效。
