Jing Chu-Yu, Li Sheng-Nan, Shan Bo-Er, Zhang Wei, Tian Wen-Juan, Ren Yu-Lan, Wang Hua-Ying
Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Gynecology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Clin Med Insights Oncol. 2022 Jul 18;16:11795549221110522. doi: 10.1177/11795549221110522. eCollection 2022.
In reproductive-aged women, the incidence of atypical endometrial hyperplasia (AEH) or endometrioid endometrial carcinoma (EEC) is rising globally. The study aimed to investigate the effectiveness of hysteroscopic curettage followed by megestrol acetate (MA) plus metformin as conservative treatment in AEH and early EEC.
We retrospectively studied AEH and stage IA, grade 1 EEC patients treated with hysteroscopic curettage followed by MA (160 mg/d) plus metformin (1500 mg/d) from January 2010 to December 2020 at Fudan University Shanghai Cancer Center. Treatment outcomes were assessed by complete response (CR) rate, recurrence rate, and pregnancy outcomes. Univariate and multivariate analyses were performed via the logistic regression model.
The study included 79 patients, 31 (39.2%) with AEH and 48 (60.8%) with EEC. The medians of age (years) and follow-up time (months) were 30 and 39.5, respectively. Seventy-six patients (96.2%) finally achieved CR. The median time to CR was 3.6 (3.0-20.6) months. The CR rate after 3 months, 6 months, and 1 year was 55 (69.6%), 67 (84.8%), and 72 (91.1%), respectively. Recurrence occurred in 26 (34.2%) patients. Treatment duration ⩾9 months was associated with a lower recurrence rate after CR ( = .012). Fourteen (93.3%) of the 15 recurrent patients who received progestin re-treatment achieved CR again. Finally, 29 patients delivered live births.
Hysteroscopy followed by MA plus metformin can achieve CR in short time and is overall safe. Consolidation treatment should be prolonged to decrease the recurrence rate, despite a shorter time to CR.
在育龄妇女中，非典型子宫内膜增生（AEH）或子宫内膜样腺癌（EEC）的全球发病率正在上升。本研究旨在探讨宫腔镜刮宫术联合醋酸甲地孕酮（MA）加二甲双胍作为AEH和早期EEC保守治疗的有效性。
我们回顾性研究了2010年1月至2020年12月在复旦大学附属肿瘤医院接受宫腔镜刮宫术，随后服用MA（160mg/d）加二甲双胍（1500mg/d）治疗的AEH和IA期1级EEC患者。通过完全缓解（CR）率、复发率和妊娠结局评估治疗效果。通过逻辑回归模型进行单因素和多因素分析。
该研究纳入79例患者，其中31例（39.2%）为AEH，48例（60.8%）为EEC。年龄（岁）和随访时间（月）的中位数分别为30岁和39.5个月。76例患者（96.2%）最终达到CR。达到CR的中位时间为3.6（3.0 - 20.6）个月。3个月、6个月和1年后的CR率分别为55例（69.6%）、67例（84.8%）和72例（91.1%）。26例（34.2%）患者复发。治疗持续时间≥9个月与CR后较低的复发率相关（P = 0.012）。15例接受孕激素再治疗的复发患者中有14例（93.3%）再次达到CR。最后，29例患者顺产。
宫腔镜检查后联合MA加二甲双胍可在短时间内实现CR，总体安全。尽管达到CR的时间较短，但巩固治疗应延长以降低复发率。
