Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Genertec Universal Medical Group Company Limited, Beijing, China.
Cancer Prev Res (Phila). 2020 Apr;13(4):403-410. doi: 10.1158/1940-6207.CAPR-19-0399. Epub 2020 Feb 3.
The aim of this work was to evaluate the risk factors for recurrence in young patients with atypical endometrial hyperplasia and early-stage endometrioid adenocarcinoma after fertility-sparing treatments (FST). A retrospective case-control study was designed. Patients with atypical endometrial hyperplasia and early-stage endometrioid adenocarcinoma who received FSTs from January 2010 to December 2017 were reviewed. All patients who met the inclusion criteria were divided into a recurrence group and a control group. Risk factors for recurrence- and disease-free survival were evaluated by logistic regression analysis and Cox regression analysis. A total of 127 patients were included, 53 patients in the recurrence group and 74 patients in the control group. No deaths occurred during the follow-up time. The rate of successful pregnancy was 62.5% in the control group and 20.5% in the recurrence group after complete remission (CR) of the primary disease. In a multivariate regression model, after adjusting for other factors, menstruation cycle, progestin type, and regular maintenance treatments after CR were the main risk factors for disease recurrence. Gonadotropin-releasing hormone agonist was mainly used to treat obese patients and was associated with longer progression-free survival (PFS) time compared with that in patients who received high-dose oral progestin such as megestrol acetate [risk ratio (RR), 2.158; 95% confidence interval (CI), 0.948-4.913]. Regular oral progestin also significantly prolonged the PFS time (RR, 4.726; 95% CI, 2.672-8.359). The progestin type used in treatment and regular maintenance treatment of young patients with atypical endometrial hyperplasia and early-stage endometrioid adenocarcinoma after CR might be correlated with disease recurrence.
本研究旨在评估接受保留生育功能治疗（FST）后的年轻非典型子宫内膜增生和早期子宫内膜样腺癌患者复发的相关风险因素。本研究采用回顾性病例对照研究设计。回顾性分析 2010 年 1 月至 2017 年 12 月期间接受 FST 的非典型子宫内膜增生和早期子宫内膜样腺癌患者。所有符合纳入标准的患者均分为复发组和对照组。采用 logistic 回归分析和 Cox 回归分析评估复发和无病生存的风险因素。共纳入 127 例患者，其中复发组 53 例，对照组 74 例。随访期间无死亡病例。对照组疾病完全缓解（CR）后成功妊娠率为 62.5%，复发组为 20.5%。在多变量回归模型中，在校正其他因素后，月经周期、孕激素类型和 CR 后规律维持治疗是疾病复发的主要危险因素。促性腺激素释放激素激动剂主要用于治疗肥胖患者，与接受醋酸甲地孕酮等大剂量口服孕激素治疗的患者相比，无进展生存期（PFS）更长[风险比（RR），2.158；95%置信区间（CI），0.948-4.913]。规律口服孕激素也显著延长了 PFS 时间（RR，4.726；95%CI，2.672-8.359）。CR 后用于治疗年轻非典型子宫内膜增生和早期子宫内膜样腺癌患者的孕激素类型和规律维持治疗可能与疾病复发相关。
