Roh Hyun Jin, Yoon Hyung Joon, Jeong Dae Hoon, Lee Tae Hwa, Kwon Byung Su, Suh Dong Soo, Kim Ki Hyung
Department of Obstetrics and Gynecology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, South Korea.
Department of Obstetrics and Gynecology, Pusan National University School of Medicine, and Biomedical Research Institute and Pusan Cancer Center, Pusan National University Hospital, Busan, South Korea.
J Res Med Sci. 2021 Jul 31;26:48. doi: 10.4103/jrms.JRMS_103_20. eCollection 2021.
The aim of this study was to evaluate efficacy of various fertility-preservative treatments with progestin and analyze prognostic factors in Stage 1A of endometrial cancer.
This retrospective study involved four Korean university hospitals. Data were collected from 43 women who were under the age of 40 with presumed stage IA endometrial cancer determined by magnetic resonance imaging and treated from January 2014 to December 2017. All of the patients were administered hormonal therapy for fertility preservation. Twenty-five patients received oral progestin with a levonorgestrel-releasing intrauterine system (LNG-IUS) for 6-24 months, and 18 patients received high-dose oral progestin for the same period of time. Oncologic outcomes were evaluated. Prognostic factors for pathologic response to progestin were identified by logistic regression analysis.
Complete response (CR) was achieved by 72.1% of patients (31/43), and the average time to CR was 4.2 (Stable disease [SD] 3.4) months (range, 3-9 months). Partial response was achieved by 7.0% of patients (3/43), SD by 9.3% (4/43), and progressive disease by 11.6% (5/43). Of the CR patients, 41.9% (13/31) achieved pregnancy with the median follow-up period of 12.5 (SD 7.6) months (range: 3-50 months). No irreversible toxicity or therapy-associated death occurred. Multivariate analysis showed that high endometrial thickness ratio of pre- and posttreatment measured at 2 months from the treatment initiation (≥0.55, Odds ratio [OR]: 19.018; 95% confidence intervals (CI): 1.854-195.078; = 0.013) and oral progestin without LNG-IUS (OR: 13.483; 95% CI: 1.356-134.069; = 0.026) might be related with unfavorable prognostic factors for CR.
This study shows that progestin-based fertility-preservative treatment might be a feasible option for stage 1A endometrial cancer. It also identifies that low endometrial thickness ratio and oral progestin with LNG-IUS combination therapy might be related with favorable response to hormonal treatment.
本研究旨在评估各种孕激素生育保留治疗的疗效，并分析子宫内膜癌1A期的预后因素。
这项回顾性研究涉及四家韩国大学医院。收集了2014年1月至2017年12月期间43名年龄在40岁以下、经磁共振成像确定为假定1A期子宫内膜癌并接受治疗的女性的数据。所有患者均接受了生育保留的激素治疗。25名患者接受口服孕激素联合左炔诺孕酮宫内节育系统（LNG-IUS）治疗6至24个月，18名患者在同一时期接受高剂量口服孕激素治疗。评估肿瘤学结局。通过逻辑回归分析确定孕激素病理反应的预后因素。
72.1%（31/43）的患者实现了完全缓解（CR），达到CR的平均时间为4.2（疾病稳定[SD]为3.4）个月（范围3至9个月）。7.0%（3/43）的患者实现部分缓解，9.3%（4/43）为疾病稳定，11.6%（5/43）为疾病进展。在CR患者中，41.9%（13/31）实现妊娠，中位随访期为12.5（SD 7.6）个月（范围：3至50个月）。未发生不可逆毒性或治疗相关死亡。多因素分析显示，治疗开始后2个月测量的治疗前后子宫内膜厚度比值较高（≥0.55，比值比[OR]：19.018；95%置信区间[CI]：1.854至195.078；P = 0.013）以及未使用LNG-IUS的口服孕激素（OR：13.483；95%CI：1.356至134.069；P = 0.026）可能与CR的不良预后因素有关。
本研究表明，基于孕激素的生育保留治疗可能是1A期子宫内膜癌的一种可行选择。研究还发现，低子宫内膜厚度比值以及口服孕激素与LNG-IUS联合治疗可能与激素治疗的良好反应有关。
