在保留生育功能治疗非典型子宫内膜增生和早期子宫内膜癌患者中，珠穆朗玛峰样化生的临床意义。
Clinical implications of morular metaplasia in fertility-preserving treatment for atypical endometrial hyperplasia and early endometrial carcinoma patients.
机构信息
Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, No. 419, Fangxie Road, Shanghai, 200011, People's Republic of China.
Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200011, People's Republic of China.
出版信息
Arch Gynecol Obstet. 2022 Oct;306(4):1135-1146. doi: 10.1007/s00404-021-06382-3. Epub 2022 Mar 4.
OBJECTIVE
Morular metaplasia (MM) is a benign epithelial metaplasia that sometimes appears in atypical endometrial hyperplasia (AEH) and endometrioid endometrial carcinoma (EEC). However, the clinical implications of MM for fertility-preserving treatment in AEH and EEC patients are unclear. This study investigated the clinical features and impact of MM on the efficacy of fertility-preserving treatment.
METHODS
We retrospectively studied 427 AEH and EEC patients who received fertility-preserving treatment. Clinical features, treatment efficacy, and onco-fertility results were compared between patients with and without MM.
RESULTS
MM appeared in 147 of 427 (34.4%) patients. Among them, 49 (33.3%) had MM only before treatment (BEF group), 32 (21.8%) had sustained MM before and during treatment (SUS group), and 66 (44.9%) had MM only during treatment (DUR group). The BEF group had a higher 12-month CR rate (98.0% vs 85.7%, p = 0.017) and shorter therapeutic duration to achieve CR (4.0 vs 5.7 months, p = 0.013) than the non-MM group had. In comparison with the non-MM group, the SUS and DUR groups had a lower CR rate after 7 months of treatment (SUS vs non-MM, 37.5% vs 61.1%, p = 0.010; DUR vs non-MM 33.3% vs. 61.1%, p < 0.001), and a longer median therapeutic duration to achieve CR (SUS vs non-MM, 7.6 vs. 4.0 months, p = 0.037; DUR vs non-MM, 7.9 vs. 4.0 months, p < 0.001).
CONCLUSION
Appearance of MM only before treatment was positively correlated with outcome of fertility-preserving treatment, while sustained MM or appearance of MM only during treatment implied poorer outcome of fertility-preserving treatment in AEH and EEC patients.
目的
嗜酸性粒细胞化生（MM）是一种良性上皮化生，有时出现在非典型子宫内膜增生症（AEH）和子宫内膜样腺癌（EEC）中。然而，MM 对 AEH 和 EEC 患者保留生育力治疗的临床意义尚不清楚。本研究探讨了 MM 对保留生育力治疗疗效的影响。
方法
我们回顾性研究了 427 例接受保留生育力治疗的 AEH 和 EEC 患者。比较了有和无 MM 的患者之间的临床特征、治疗效果和生育肿瘤学结果。
结果
MM 出现在 427 例患者中的 147 例（34.4%）。其中，49 例（33.3%）仅在治疗前有 MM（BEF 组），32 例（21.8%）在治疗前和治疗期间持续有 MM（SUS 组），66 例（44.9%）仅在治疗期间有 MM（DUR 组）。BEF 组 12 个月的完全缓解率（CR）更高（98.0% vs 85.7%，p=0.017），达到 CR 的治疗时间更短（4.0 个月 vs 5.7 个月，p=0.013）。与非 MM 组相比，SUS 组和 DUR 组在治疗 7 个月后 CR 率较低（SUS 组 vs 非 MM 组，37.5% vs 61.1%，p=0.010；DUR 组 vs 非 MM 组，33.3% vs 61.1%，p<0.001），达到 CR 的中位治疗时间更长（SUS 组 vs 非 MM 组，7.6 个月 vs 4.0 个月，p=0.037；DUR 组 vs 非 MM 组，7.9 个月 vs 4.0 个月，p<0.001）。
结论
仅在治疗前出现 MM 与保留生育力治疗的结局呈正相关，而持续存在 MM 或仅在治疗期间出现 MM 提示 AEH 和 EEC 患者保留生育力治疗的结局较差。
Zotero 插件