Department of Women's and Children's Health, Uppsala University, 751 85, Uppsala, Sweden.
Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, 171 77, Stockholm, Sweden.
Sci Rep. 2023 Apr 11;13(1):5861. doi: 10.1038/s41598-023-32911-y.
Conservative management of endometrial cancer (CMEC) is viable for women with early-stage disease wishing to preserve fertility, but there is poor knowledge regarding clinicians' attitudes towards treatment or guidelines adherence. This 55-item survey study investigated CMEC-related experience, practice and attitudes among clinically active Swedish gynecologists and gynecological oncologists, focusing on reproductive eligibility criteria. The survey consisted of a general and two specific subsets, selectively delivered to clinicians active in infertility (subset A) and endometrial cancer (subset B) care. Answers from 218 clinicians were included. More than half agreed on CMEC whereas only 5% explicitly disagreed. The majority supported a fertility work-up to substantiate reasonable chances to pregnancy and live birth. Most disagreed about CMEC in case of previous unsuccessful fertility treatments, while more than 1/3 disagreed about CMEC in known fertility problems, recurrent miscarriages or previous children. Over 50% of respondents in subset A (n = 107) found it applicable with fertility investigations such as ovarian reserve testing or, in case of male partner, semen analysis. Respondents in subset B (n = 165) agreed on items based on existing recommendations regarding the oncological management of CMEC, including the use of continuous progestins, hysteroscopic resection of macroscopic lesions, control biopsy with curettage or hysteroscopy after 6 months of treatment, pursuing pregnancy as soon as possible after complete response, and performing a hysterectomy once live birth is achieved. While many clinicians were familiar with CMEC, the overall experience is limited. Fertility specialists seem less involved than oncologists in patient care but there is broad support for fertility-related eligibility criteria.
对于希望保留生育能力的早期疾病女性，子宫内膜癌的保守管理（CMEC）是可行的，但对于临床医生对治疗或指南遵循的态度知之甚少。这项 55 项的调查研究调查了在生育方面活跃的瑞典妇科医生和妇科肿瘤学家与 CMEC 相关的经验、实践和态度，重点是生殖资格标准。该调查由一般和两个具体子集组成，选择性地提供给在不孕症（子集 A）和子宫内膜癌（子集 B）护理方面活跃的临床医生。共有 218 名临床医生回答了问题。超过一半的人同意 CMEC，而只有 5%的人明确表示不同意。大多数人支持进行生育检查，以证实合理的妊娠和活产机会。大多数人不同意在先前的生育治疗失败的情况下进行 CMEC，但超过 1/3 的人不同意在已知的生育问题、反复流产或以前有孩子的情况下进行 CMEC。在子集 A（n=107）的 50%以上的受访者认为，在存在生育问题的情况下进行生育调查是适用的，如卵巢储备测试，或者在男性伴侣的情况下，进行精液分析。在子集 B（n=165）的受访者同意根据现有的关于 CMEC 的肿瘤管理建议的项目，包括使用连续孕激素、宫腔镜切除宏观病变、在治疗 6 个月后进行刮宫或宫腔镜控制活检、在完全缓解后尽快尝试妊娠，以及一旦实现活产就进行子宫切除术。虽然许多临床医生对 CMEC 很熟悉，但总体经验有限。生育专家似乎不如肿瘤学家更多地参与患者护理，但广泛支持与生育相关的资格标准。
