Factors affecting pregnancy outcomes in young women treated with fertility-preserving therapy for well-differentiated endometrial cancer or atypical endometrial hyperplasia.
Factors affecting pregnancy outcomes in young women treated with fertility-preserving therapy for well-differentiated endometrial cancer or atypical endometrial hyperplasia.
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DOI：
10.1186/s12958-015-0136-7
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发表时间：
2016-01-15
期刊：
影响因子：
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通讯作者：
Aoki D
中科院分区：
文献类型：
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作者：
Inoue O;Hamatani T;Susumu N;Yamagami W;Ogawa S;Takemoto T;Hirasawa A;Banno K;Kuji N;Tanaka M;Aoki D
希望保留生育能力的患者接受高剂量醋酸甲羟孕酮（MPA）保守治疗高分化子宫内膜样腺癌（EC）或子宫内膜非典型增生（AEH）。这种治疗通常涉及频繁的子宫内手术，包括扩张和刮宫（D&C）和子宫内膜活检（EMB），这可能导致子宫内膜炎，子宫内膜变薄或子宫内粘连。反过来，这些结果中的任何一个都可能对着床和妊娠发育产生不利影响。因此，目前的研究旨在确定可能影响MPA保守治疗后妊娠的因素。我们比较了妊娠组（45例患者）和非妊娠组（53例患者）的MPA治疗患者，以评估影响临床妊娠建立的因素。我们进行了多因素logistic回归分析的基础上，单因素分析显示，组间有显着差异的因素。单因素分析确定了D&C的数量，子宫内膜厚度，MPA管理的持续时间，怀孕许可的年龄（患者在病变消失后首次被允许尝试怀孕的年龄），病变消失的时间和复发作为独立变量。多因素分析疾病复发、排卵期子宫内膜厚度和允许怀孕年龄的比值比（95%可信区间）分别为0.283（0.102-0.785）、1.677（1.251-2.248）和0.889（0.792-0.998）。其他自变量组间差异无统计学意义。我们确定了三个因素被认为是影响MPA保守治疗后怀孕的建立：复发，排卵期子宫内膜厚度和怀孕许可的年龄。因此，在MPA实现肿瘤消失后不久引入包括辅助生殖技术（ART）在内的不孕治疗对疾病复发、子宫内膜薄或允许怀孕年龄较高的患者有益。本文的在线版本（doi：10.1186/s12958-015-0136-7）包含补充材料，可供授权用户使用。
Patients hoping to preserve their fertility receive conservative treatment with high-dose medroxyprogesterone acetate (MPA) for well-differentiated endometrioid adenocarcinoma (EC) or atypical endometrial hyperplasia (AEH) . Such treatment generally involves frequent intrauterine operations, including dilation and curettage (D&C) and endometrial biopsy (EMB), which could result in endometritis, endometrial thinning, or intrauterine adhesion. In turn, any of these outcomes could adversely affect implantation and pregnancy development. The current study thus aimed to identify factors that might affect pregnancy following conservative treatment by MPA. We compared a pregnancy group (45 patients) with a non-pregnancy group (53 patients) of MPA-treated patients to evaluate the factors affecting clinical pregnancy establishment. We undertook a multivariate logistic regression analysis based on factors shown by univariate analysis to be significantly different between the groups. Univariate analysis identified number of D&C, endometrial thickness, duration of MPA administration, age of pregnancy permission (the age at which a patient was first allowed to attempt pregnancy after disappearance of the lesion), period of disappearance of lesions, and recurrence as independent variables. The odds ratios (95 % confidence interval) of multivariate analysis for disease recurrence, endometrial thickness during ovulation, and age of pregnancy permission were 0.283 (0.102–0.785), 1.677 (1.251–2.248), and 0.889 (0.792–0.998), respectively. There was no significant difference in the other independent variables between groups. We identified three factors considered to affect pregnancy establishment following conservative treatment with MPA: recurrence, endometrial thickness during ovulation, and the age of the pregnancy permission. Introduction of infertility treatment including assisted reproductive technology (ART) soon after achieving tumor disappearance by MPA would therefore be beneficial for patients with disease recurrence, thin endometrium, or a higher age of pregnancy permission. The online version of this article (doi:10.1186/s12958-015-0136-7) contains supplementary material, which is available to authorized users.