Long-term outcomes of progestin plus metformin as a fertility-sparing treatment for atypical endometrial hyperplasia and endometrial cancer patients
Long-term outcomes of progestin plus metformin as a fertility-sparing treatment for atypical endometrial hyperplasia and endometrial cancer patients
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DOI：
10.3802/jgo.2019.30.e90
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发表时间：
2019-11-01
影响因子：
3.9
通讯作者：
Shozu, Makio
中科院分区：
文献类型：
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作者：
Mitsuhashi, Akira;Habu, Yuji;Shozu, Makio
目的：探讨醋酸甲羟孕酮（MPA）联合二甲双胍治疗对非典型子宫内膜增生（AEH）和子宫内膜癌（EC）的远期疗效及治疗后受孕情况。方法：我们回顾性分析了63例患者（42例EC， 21例AEH），这些患者接受了MPA加二甲双胍的生育保护管理。给予MPA （400mg /天）和二甲双胍（750- 2250mg /天）以达到完全缓解（CR）。二甲双胍一直使用到怀孕，甚至在停药后。结果：48例（76%）患者体重指数(BMI) >= 25 kg/m(2)， 43例（68%）患者出现胰岛素抵抗。61例患者（97%）在18个月内达到CR。6个月、8-9个月和12个月的CR率分别为60%、84%和90%。在中位随访57个月（范围13-115个月）期间，61例达到CR的患者中有8例（13.1%）复发，所有患者5年无复发生存率（RFS）为84.8%。单因素分析显示，BMI = 25 kg/m(2)的患者预后明显好于BMI = 25 kg/m(2)的患者。
Objective: The present study investigated long-term outcomes of medroxyprogesterone acetate (MPA) plus metformin therapy in terms of control of atypical endometrial hyperplasia (AEH) and endometrial cancer (EC), and post-treatment conception.Methods: We retrospectively analyzed 63 patients (42 with EC; 21 with AEH) who underwent fertility-sparing management using MPA plus metformin. MPA (400 mg/day) and metformin (750-2,250 mg/day) were administered to achieve complete response (CR). Metformin was administered until conception, even after MPA discontinuation.Results: Of the total patients, 48 (76%) had a body mass index (BMI) >= 25 kg/m(2) and 43 (68%) showed insulin resistance. Sixty-one patients (97%) achieved CR within 18 months. CR rates at 6, 8-9, and 12 months were 60%, 84%, and 90%, respectively. During a median follow-up period of 57 months (range, 13-115 months), relapse occurred in 8 of 61 patients (13.1%) who had achieved CR. Relapse-free survival (RFS) in all patients at 5 years was 84.8%. Upon univariate analysis, patients with BMI >= 25 kg/m(2) had significantly better prognoses than did those with BMI = 25 kg/m(2).