AP-HP, Department of Obstetrics and Gynecology, Hôpital Bichat-Claude Bernard, Paris, France; Université de Paris, Paris, France.
AP-HP, Department of Reproductive Medicine and Fertility Preservation, Hôpital Jean Verdier, Bondy, France; Université Sorbonne Paris Nord, Paris, France.
Reprod Biomed Online. 2021 Sep;43(3):495-502. doi: 10.1016/j.rbmo.2021.06.007. Epub 2021 Jun 16.
Do IVF treatments after conservative management of endometrial atypical hyperplasia or grade 1 endometrial adenocarcinoma (AH/EC) increase the risk of disease recurrence?
This is a prospective cohort study from a national registry from January 2008 to July 2019. Sixty patients had an AH/EC and received progestin treatment using chlormadinone acetate for at least 3 months. After remission, 31 patients underwent IVF and 29 did not. The primary outcome was the recurrence rate at 24 months according to the use of IVF. The secondary outcome was the identification of risk factors for recurrence.
The probability of 2-year recurrence was 37.7% (SD 10.41%) in the IVF group and 55.7% (SD 14.02%) in the no IVF group (P = 0.13). Obesity, nulliparity, polycystic ovary syndrome, age and tumoural characteristics were not associated with recurrence. Pregnancy was a protective factor for recurrence, with 2-year recurrence probabilities of 20.5% and 62.0% in the pregnancy and no pregnancy groups, respectively (P = 0.002, 95% CI 0.06-0.61). In contrast, the number of cycles, maximum serum oestradiol concentration during ovarian stimulation, ovarian stimulation protocol, total dose of gonadotrophin administered and thickness of the endometrium showed no significant differences in terms of the risk of recurrence in the IVF subgroup.
IVF treatment after fertility-sparing management of AH/EC does not increase the risk of recurrence. Therefore, it is an acceptable strategy to decrease the time to pregnancy. Overall, the recurrence rate is high enough to justify close monitoring once remission occurs.
对于子宫内膜非典型增生或 1 级子宫内膜腺癌（AH/EC）的保守管理后进行 IVF 治疗是否会增加疾病复发的风险？
这是一项从 2008 年 1 月至 2019 年 7 月的全国注册登记处进行的前瞻性队列研究。60 例患者患有 AH/EC，并接受醋酸氯地孕酮至少 3 个月的孕激素治疗。缓解后，31 例患者接受了 IVF，29 例未接受。主要结局是根据使用 IVF 在 24 个月时的复发率。次要结局是确定复发的危险因素。
在 IVF 组中，2 年复发率为 37.7%（SD 10.41%），在未接受 IVF 组中为 55.7%（SD 14.02%）（P=0.13）。肥胖、不孕、多囊卵巢综合征、年龄和肿瘤特征与复发无关。妊娠是复发的保护因素，妊娠组和未妊娠组的 2 年复发率分别为 20.5%和 62.0%（P=0.002，95%CI 0.06-0.61）。相比之下，在 IVF 亚组中，周期数、卵巢刺激期间最大血清雌二醇浓度、卵巢刺激方案、给予的促性腺激素总剂量和子宫内膜厚度与复发风险无显著差异。
在 AH/EC 的生育保留治疗后进行 IVF 治疗不会增加复发的风险。因此，这是一种可以接受的策略，可以减少妊娠时间。总体而言，复发率足够高，一旦缓解发生，就需要密切监测。
