Suzuki Yukio, Huang Yongmei, Xu Xiao, Ferris Jennifer S, Elkin Elena B, Kong Chung Yin, Myers Evan R, Saji Haruya, Miyagi Etsuko, Havrilesky Laura J, Blank Stephanie V, Hershman Dawn L, Wright Jason D
Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.
Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan.
JAMA Oncol. 2025 Aug 28. doi: 10.1001/jamaoncol.2025.2761.
As the number of young women with early-stage endometrial cancer is increasing, there is growing interest in use of progesterone-based therapy to allow fertility preservation.
To ascertain the long-term survival of premenopausal women with clinical stage I endometrial cancer treated primarily with fertility-preserving hormonal therapy compared with hysterectomy.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from the National Cancer Database to identify female patients aged 18 to 49 years with clinical stage I, grade 1 to 2, endometrioid endometrial cancer diagnosed from 2004 through 2020. In addition, trends in and factors associated with the use of fertility-preserving hormonal therapy were examined. Propensity score matching was used to compare survival among patients treated primarily with fertility-preserving hormonal therapy and those treated with hysterectomy. Data were analyzed from November 2023 to January 2024.
Primary treatment was defined as hysterectomy or fertility-preserving hormonal therapy based on days from diagnosis to operation or fertility-preserving hormonal therapy.
Time to all-cause mortality was measured in months from cancer diagnosis to death or last follow-up at 2-year, 5-year, and 10-year intervals.
A total of 15 849 women, including 14 662 (92.5%) treated with primary hysterectomy (mean [IQR] age, 44 [39-47] years]) and 1187 (7.5%) who received primary hormonal therapy (mean [IQR] age, 34 [30-38] years) were identified. The use of hormonal treatment increased from 5.2% in 2004 to 13.8% in 2020 (P < .001). After propensity score matching, 5-year survival was 98.5% (95% CI, 97.3%-99.2%) for primary hysterectomy and 96.8% (95% CI, 95.3%-97.8%) for primary hormonal therapy (hazard ratio [HR] = 1.84; 95% CI, 1.06-3.21). Among patients younger than 40 years, there was no difference in survival between hysterectomy and hormonal therapy (HR = 1.00; 95% CI, 0.50-2.00). However, for patients aged 40 to 49 years, fertility-preserving hormonal therapy was associated with a significantly increased risk of death (HR = 4.94; 95% CI, 1.89-12.91).
This study found that the use of fertility-preserving hormonal therapy among reproductive age patients with early-stage endometrial cancer has increased over time. While overall survival in patients with hormonal therapy is shorter than with hysterectomy, survival for patients younger than 40 years of age is comparable after primary treatment with fertility-preserving hormonal therapy or hysterectomy.
随着早期子宫内膜癌年轻女性数量的增加，人们对使用基于孕激素的疗法来保留生育能力的兴趣日益浓厚。
确定与子宫切除术相比，主要接受保留生育功能的激素治疗的绝经前临床I期子宫内膜癌女性的长期生存率。
设计、设置和参与者：这项队列研究使用了国家癌症数据库的数据，以识别2004年至2020年期间诊断为临床I期、1至2级、子宫内膜样子宫内膜癌的18至49岁女性患者。此外，还研究了保留生育功能的激素治疗的使用趋势及其相关因素。采用倾向评分匹配法比较主要接受保留生育功能的激素治疗的患者和接受子宫切除术的患者的生存率。数据于2023年11月至2024年1月进行分析。
主要治疗方法根据从诊断到手术或保留生育功能的激素治疗的天数定义为子宫切除术或保留生育功能的激素治疗。
从癌症诊断到死亡或末次随访，以月为单位测量全因死亡时间，随访间隔为2年、5年和10年。
共识别出15849名女性，其中14662名（92.5%）接受了初次子宫切除术（平均[四分位间距]年龄为44[39 - 47]岁），1187名（7.5%）接受了初次激素治疗（平均[四分位间距]年龄为34[30 - 38]岁）。激素治疗的使用从2004年的5.2%增加到2020年的13.8%（P < 0.001）。倾向评分匹配后，初次子宫切除术的5年生存率为98.5%（95%置信区间，97.3% - 99.2%），初次激素治疗的5年生存率为96.8%（95%置信区间，95.3% - 97.8%）（风险比[HR] = 1.84；95%置信区间，1.06 - 3.21）。在40岁以下的患者中，子宫切除术和激素治疗的生存率没有差异（HR = 1.00；95%置信区间，0.50 - 2.00）。然而，对于40至49岁的患者，保留生育功能的激素治疗与死亡风险显著增加相关（HR = 4.94；95%置信区间，1.89 - 12.91）。
本研究发现，随着时间的推移，生育年龄的早期子宫内膜癌患者中保留生育功能的激素治疗的使用有所增加。虽然接受激素治疗的患者总体生存率低于子宫切除术，但40岁以下患者在接受保留生育功能的激素治疗或子宫切除术后的生存率相当。
