He Y J, Wang Y Q, Tang H R, He M, Rao Y, Zhou R, Wang J L
Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China.
Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen 518036, China.
Zhonghua Fu Chan Ke Za Zhi. 2020 Jan 25;55(1):21-28. doi: 10.3760/cma.j.issn.0529-567X.2020.01.005.
To analyze the clinical efficacy and pregnancy outcomes of fertility- preserving re-treatment in patients with recurrent atypical endometrial hyperplasia (AEH) and early stage endometrial carcinoma (EEC) after achieved complete remission (CR) of primary fertility-preserving therapy. There were 104 cases of AEH and EEC collected from 9 hospitals in the multi-center research network platform of fertility-preserving therapy of endometrial carcinoma in China from January 2005 to May 2019. Thirth-one cases of them relapsed from four hospitals mentioned above,who achieved CR after primary fertility-preserving therapy,was analyzed retrospectively. Of the 31 cases, 27 cases chose fertility-preserving re-treatment. The demographic characteristics, re-treatment effect, clinical factors and pregnancy outcomes were observed. (1) There were 16 AEH cases and 11 ECC cases among 27 recurrent patients who chose fertility-preserving therapy again. After re-treatment, CR was found in 13 out of 16 cases of AEH and 9 out of 11 cases of EEC. The overall CR rate was 81% (22/27). (2) After CR of recurrence, 5 cases (23%, 5/22) of re-recurrence were found after with a median time of 33 months (range 21-80 months). There were 4 cases underwent comprehensive surgical staging, and 1 patient chose the third round of fertility preservation therapy with fully informed consent, and CR was reached after 15 months. (3) There were 16 cases with pregnancy intention, with a total of 12 pregnancies, including 5 cases were natural pregnancy and 7 cases were assisted reproductive technology pregnancy. There were 5 live births. The follow-up time was up to May 2019, and the median follow-up time was 73 months (range 0-123 months). All 27 patients had disease free survival. Recurrent patients with AEH and EEC after achieving successful fertility-preserving therapy could choose fertility-preserving therapy again with comprehensive assessment and fully informed consent. After re-treatment, there is a certain tumor CR rate and pregnancy rate, while the close follow-up is required during treatment.
分析复发性非典型子宫内膜增生（AEH）和早期子宫内膜癌（EEC）患者在初次保留生育功能治疗获得完全缓解（CR）后，再次进行保留生育功能治疗的临床疗效及妊娠结局。从2005年1月至2019年5月在中国子宫内膜癌保留生育功能治疗多中心研究网络平台的9家医院收集了104例AEH和EEC病例。对其中4家医院的31例初次保留生育功能治疗后复发且获得CR的患者进行回顾性分析。在这31例患者中，27例选择了再次保留生育功能治疗。观察其人口统计学特征、再次治疗效果、临床因素及妊娠结局。（1）27例再次选择保留生育功能治疗的复发患者中，有16例AEH和11例ECC。再次治疗后，16例AEH中有13例达到CR，11例EEC中有9例达到CR。总体CR率为81%（22/27）。（2）复发CR后，5例（23%，5/22）再次复发，中位时间为33个月（范围21 - 80个月）。4例接受了全面手术分期，1例患者在充分知情同意后选择了第三轮保留生育功能治疗，15个月后达到CR。（3）有16例有妊娠意愿，共妊娠12次，其中自然妊娠5例，辅助生殖技术妊娠7例。有5例活产。随访至2019年5月，中位随访时间为73个月（范围0 - 123个月）。27例患者均无病生存。初次保留生育功能治疗成功后的AEH和EEC复发患者，经综合评估及充分知情同意后可再次选择保留生育功能治疗。再次治疗后有一定的肿瘤CR率和妊娠率，治疗期间需密切随访。
