Department of Obstetrics and Gynecology, Chia-Yi Chang Gung Memorial Hospital, Chia-Yi, Taiwan; Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Eur J Obstet Gynecol Reprod Biol. 2021 Dec;267:99-104. doi: 10.1016/j.ejogrb.2021.10.026. Epub 2021 Oct 29.
Fertility-sparing progestin therapy is highly effective in selected young women with endometrial cancer. In present study, we attempted to evaluate the role of prolonged medication and identify factors predicting successful treatment, and also assess fertility outcomes among young women with early stage endometrial endometrioid carcinoma (EC).
We retrospectively reviewed clinical data from patients aged <45 years with well-differentiated EC at presumed stage IA (without myometrial invasion) who wished to preserve fertility. They were managed with oral progestin at Kaohsiung Chang Gung Memorial Hospital between June 2005 and June 2019.
Forty-five patients were included with a median follow-up of 53.5 months (range 12-170 months). Forty-one patients (91.1%) had complete remission, the cumulative complete response (CR) rates at 3, 6, 9, 12, and >12 months were 17.7%, 48.9%, 60.0%, 68.9% and 91.1%, respectively. Among the 41 responders, 23 attempted to conceive and nine (39.1%) achieved pregnancy with 12 live newborn infants. Eleven (27.5%) responders experienced recurrence at a median of 22 months from CR (range 3-54 months). Multivariate Cox regression analysis revealed that non-diabetes (HR: 4.59; 95% CI: 1.62-12.98) and endometrial thickness <2 cm (HR: 0.39; 95% CI: 1.41-17.67) were significantly factors associated with treatment response.
We concluded that prolonged oral progestin treatment was possible with a certain proportion of responders (24.4%) being responded after one year. Diabetes controlled on metformin and endometrial thickness <2 cm could be used as surrogate markers to predict better treatment response.
孕激素保留治疗在特定的年轻子宫内膜癌患者中非常有效。本研究试图评估延长药物治疗的作用，确定预测治疗成功的因素，并评估早期子宫内膜子宫内膜样癌（EC）年轻女性的生育结局。
我们回顾性分析了 2005 年 6 月至 2019 年 6 月在高雄长庚纪念医院就诊的年龄<45 岁、分化良好的假定 IA 期（无肌层浸润）EC 且希望保留生育能力的患者的临床资料。这些患者接受口服孕激素治疗。
45 例患者纳入研究，中位随访时间为 53.5 个月（12-170 个月）。41 例患者（91.1%）完全缓解，3、6、9、12 和>12 个月的累积完全缓解（CR）率分别为 17.7%、48.9%、60.0%、68.9%和 91.1%。在 41 例缓解者中，23 例尝试受孕，9 例（39.1%）妊娠，12 例活产。11 例（27.5%）缓解者在 CR 后中位时间 22 个月（3-54 个月）复发。多变量 Cox 回归分析显示，非糖尿病（HR：4.59；95%CI：1.62-12.98）和子宫内膜厚度<2cm（HR：0.39；95%CI：1.41-17.67）是与治疗反应相关的显著因素。
我们得出结论，口服孕激素延长治疗可能有一定比例的患者（24.4%）在一年后出现缓解。二甲双胍控制的糖尿病和子宫内膜厚度<2cm 可作为预测治疗反应更好的替代标志物。
