Choi Chel-Hun, Lee Yoo-Young, Lai Yen-Ling, Chang Koping, Kim Hyun-Soo, Chen Jung, Chen Yu-Li
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Obstetrics and Gynecology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.
J Gynecol Oncol. 2025 Mar;36(2):e18. doi: 10.3802/jgo.2025.36.e18. Epub 2024 Jul 8.
In this study, we evaluated the role of prolonged progestin treatment on atypical endometrial hyperplasia (AEH) patients who did not achieve complete regression (CR) after at least 3 months of progestin treatment. Possible prognostic factors predicting disease regression and recurrence were also assessed.
We retrospectively identified patients who had histologically confirmed persistent disease after at least 3 months of progestin treatment at two tertiary centers in Korea and Taiwan. Clinicopathologic factors and clinical outcomes were obtained from medical records. Logistic regression was used to analyze the relationship between covariates and the probability of CR and relapse.
Fifty-two patients were included. Thirty-seven of 52 patients (71.2%) achieved CR after prolonged progestin treatment. Median time from starting progestin treatment to CR was 12.0 months. Daily administration of medroxyprogesterone acetate ≥200 mg or megestrol acetate ≥80 mg was associated with higher probability of regression. Nineteen of 37 patients (51.4%) experienced recurrence, with median time from CR to relapse of 15.0 months. Body mass index ≥27 was associated with higher relapse probability. Twelve of 16 patients with disease progression to endometrial carcinoma underwent surgery. The 12 cases had stage I tumors and lived without disease.
Extension of progestin treatment course is feasible for AEH patients without an initial response to progestin. Higher daily progestin dosage was associated with higher probability of CR, and obesity was associated with higher risk of relapse. The patients without an initial response to progestins and whose AEH progressed to endometrial carcinoma had good prognoses.
在本研究中，我们评估了延长孕激素治疗对在接受至少3个月孕激素治疗后未实现完全消退（CR）的非典型子宫内膜增生（AEH）患者的作用。还评估了预测疾病消退和复发的可能预后因素。
我们回顾性地确定了在韩国和台湾的两个三级中心接受至少3个月孕激素治疗后经组织学证实存在持续性疾病的患者。从病历中获取临床病理因素和临床结果。使用逻辑回归分析协变量与CR和复发概率之间的关系。
纳入52例患者。52例患者中有37例（71.2%）在延长孕激素治疗后实现CR。从开始孕激素治疗到CR的中位时间为12.0个月。每日服用醋酸甲羟孕酮≥200 mg或醋酸甲地孕酮≥80 mg与更高的消退概率相关。37例患者中有19例（51.4%）复发，从CR到复发的中位时间为15.0个月。体重指数≥27与更高的复发概率相关。16例疾病进展为子宫内膜癌的患者中有12例接受了手术。这12例患者为I期肿瘤，无病生存。
对于对孕激素初始无反应的AEH患者，延长孕激素治疗疗程是可行的。每日较高的孕激素剂量与较高的CR概率相关，肥胖与较高的复发风险相关。对孕激素初始无反应且AEH进展为子宫内膜癌的患者预后良好。
