Chen Junyu, Cao Dongyan, Yang Jiaxin, Yu Mei, Zhou Huimei, Cheng Ninghai, Wang Jinhui, Zhang Ying, Peng Peng, Shen Keng
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China.
Front Oncol. 2021 Sep 9;11:738370. doi: 10.3389/fonc.2021.738370. eCollection 2021.
To evaluate the efficacy and prognosis of fertility-sparing re-treatment on patients with recurrent endometrial cancer (EC) and atypical endometrial hyperplasia (AEH) who wish to preserve their uterus after complete remission (CR) for primary conservative therapy.
We performed a retrospective study on recurrent EC or AEH patients who received fertility-sparing re-treatment after achieving CR. Data regarding clinicopathological factors, adverse events, treatment efficacy, tumor prognosis, and reproductive outcome were analyzed.
Of the 98 recurrent patients with a median disease-free interval period of 19 (3-96) months, 18 patients decided to receive hysterectomy directly, and 80 patients received fertility-preserving re-treatment. Seventy-one (88.6%) cases achieved CR, 96.0% in AEH and 75.8% in EC patients, with the 6 (3-16) months' median CR time. Seven (8.8%) patients failed to achieve CR and then underwent the hysterectomy: one partial response (PR), four stable disease (SD), and two progressive disease (PD). Forty-nine women attempted to get pregnant after CR, 13 (26.5%) became pregnant, seven (14.3%) successfully delivered, and six (12.2%) miscarried. During the follow-up period, 22 (31.0%) women had developed a second relapse with the median recurrence time of 12 (4-90) months, and 10 patients decided to receive the third round of fertility-sparing treatment. Seven (70.0%) patients, 33.3% in EC and 85.7% in AEH, achieved CR again. Hysterectomy was performed in two (20.0%) patients due to SD. After the third-round treatment, six women had the desire to conceive but no one became pregnant successfully.
For patients with recurrent EC and AEH after primary conservative treatment, fertility-preserving re-treatment can still achieve a promising response, and patients have possibilities of completing childbirth.
评估对原发性保守治疗完全缓解（CR）后希望保留子宫的复发性子宫内膜癌（EC）和非典型子宫内膜增生（AEH）患者进行保留生育功能再治疗的疗效和预后。
我们对达到CR后接受保留生育功能再治疗的复发性EC或AEH患者进行了一项回顾性研究。分析了有关临床病理因素、不良事件、治疗疗效、肿瘤预后和生殖结局的数据。
98例复发患者的无病间期中位数为19（3 - 96）个月，18例患者决定直接接受子宫切除术，80例患者接受了保留生育功能的再治疗。71例（88.6%）病例达到CR，AEH患者中为96.0%，EC患者中为75.8%，CR时间中位数为6（3 - 16）个月。7例（8.8%）患者未达到CR，随后接受了子宫切除术：1例部分缓解（PR），4例疾病稳定（SD），2例疾病进展（PD）。49名女性在CR后尝试怀孕，13例（26.5%）怀孕，7例（14.3%）成功分娩，6例（12.2%）流产。在随访期间，22例（31.0%）女性出现第二次复发，复发时间中位数为12（4 - 90）个月，10例患者决定接受第三轮保留生育功能治疗。7例（70.0%）患者再次达到CR，EC患者中为33.3%，AEH患者中为85.7%。2例（20.0%）患者因疾病稳定接受了子宫切除术。第三轮治疗后，6名女性有怀孕意愿，但无人成功怀孕。
对于原发性保守治疗后复发性EC和AEH患者，保留生育功能再治疗仍可取得较好疗效，且患者有完成分娩的可能。
