Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China.
J Gynecol Oncol. 2021 Sep;32(5):e70. doi: 10.3802/jgo.2021.32.e70. Epub 2021 May 25.
This study aimed to investigate the impact of polycystic ovary syndrome (PCOS) on fertility-sparing treatment in young patients with atypical endometrial hyperplasia (AEH) or endometrioid endometrial cancer (EEC).
A total of 285 patients with EEC (n=76, FIGO stage IA, without myometrium invasion) or AEH (n=209) who received progestin-based fertility-sparing treatment were evaluated retrospectively. Among the 285 patients, 103 (36.1%), including 70 AEH cases and 33 EEC cases, were diagnosed with PCOS. General characteristics, cumulative 16- and 32-week complete response (CR) rate, pregnancy outcome and recurrence were compared between patients with or without PCOS.
The cumulative 16-week CR rate was lower in the PCOS group than in the non-PCOS group (18.4% vs. 33.8%, p=0.006). Patients with PCOS took longer treatment duration to achieve CR (7.0 months vs. 5.4 months, p=0.006) and shorter time to relapse after CR (9.6 months vs. 17.6 months, p=0.040) compared with non-PCOS group. After adjusting for patient age, body mass index, PCOS, homeostasis model assessment-insulin resistance index, and serum testosterone levels, we found that body mass index ≥25 kg/m² (HR=0.583; 95% CI=0.365-0.932; p=0.024) and PCOS (HR=0.545; 95% CI=0.324-0.917; p=0.022) were significantly correlated with lower 16-week CR rate.
PCOS was associated with lower 16-week CR rate, longer treatment duration and shorter recurrence interval in patients with AEH or EEC receiving fertility-preserving treatment.
本研究旨在探讨多囊卵巢综合征（PCOS）对年轻患有非典型子宫内膜增生（AEH）或子宫内膜样腺癌（EEC）患者行保留生育力治疗的影响。
回顾性评估了 285 例接受孕激素为基础的保留生育力治疗的 EEC（n=76，FIGO 分期 IA，无肌层浸润）或 AEH（n=209）患者。在 285 例患者中，103 例（36.1%），包括 70 例 AEH 病例和 33 例 EEC 病例，被诊断为 PCOS。比较了 PCOS 患者和非 PCOS 患者的一般特征、16 周和 32 周累积完全缓解（CR）率、妊娠结局和复发情况。
PCOS 组的 16 周累积 CR 率低于非 PCOS 组（18.4%比 33.8%，p=0.006）。与非 PCOS 组相比，PCOS 组患者达到 CR 的治疗时间更长（7.0 个月比 5.4 个月，p=0.006），CR 后复发时间更短（9.6 个月比 17.6 个月，p=0.040）。在校正患者年龄、体重指数、PCOS、稳态模型评估-胰岛素抵抗指数和血清睾酮水平后，我们发现体重指数≥25 kg/m²（HR=0.583；95%CI=0.365-0.932；p=0.024）和 PCOS（HR=0.545；95%CI=0.324-0.917；p=0.022）与 16 周 CR 率较低显著相关。
在接受保留生育力治疗的 AEH 或 EEC 患者中，PCOS 与 16 周 CR 率较低、治疗时间较长和复发间隔较短相关。
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