Pregnancy and oncologic outcomes after fertility-sparing management for early stage endometrioid endometrial cancer
Pregnancy and oncologic outcomes after fertility-sparing management for early stage endometrioid endometrial cancer
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DOI：
10.1136/ijgc-2018-000036
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发表时间：
2019-01-01
影响因子：
4.8
通讯作者：
Kang, Soon-Beom
中科院分区：
文献类型：
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作者：
Chae, Su Hyun;Shim, Seung-Hyuk;Kang, Soon-Beom
目的激素治疗是早期子宫内膜样癌患者保留生育能力的一种替代治疗方法。本研究旨在探讨子宫内膜样子宫内膜癌激素治疗后的妊娠和肿瘤预后及成功受孕的因素。方法回顾性分析经保生育治疗的IA期1-2级子宫内膜样癌患者。同时使用甲羟孕酮和左炔诺孕酮释放子宫内装置治疗。比较妊娠组和非妊娠组的妊娠结局和肿瘤结局。结果IA期1-2级子宫内膜样癌患者71例完全缓解，其中49例尝试怀孕。妊娠22例（44.9%）；怀孕总数为30例。这些妊娠导致7例流产（23.3%），1例早产（3.3%）和20例足月分娩（66.6%）。总活产率66.6%（20/30）。在妊娠组和非妊娠组，激素治疗的中位持续时间分别为11.9个月（范围4-49）和12.0个月（范围3-35）。在多因素分析中，年龄、体重指数、治疗时间、甲羟孕酮剂量、扩张和刮刮活检次数与妊娠失败无显著相关，但与分级相关(OR 6.2, 95% CI 1.0 ~ 38.9
Objective Hormonal management is an alternative treatment for preserving fertility in patients with presumed early stage endometrioid endometrial cancer. This study aimed to define the pregnancy and oncologic outcomes and factors of successful conception after hormone therapy for endometrioid endometrial cancer.Methods We retrospectively analyzed patients presumed to have stage IA, grade 1-2 endometrioid endometrial cancer who underwent fertility-sparing treatment. Concurrent medroxyprogesterone and levonorgestrel-release intra-uterine devices were used for treatment. The pregnancy outcomes and oncologic outcomes were compared between the pregnant and non-pregnant groups.Results Seventy-one patients presumed to have stage IA, grade 1-2 endometrioid endometrial cancer had complete remission, and 49 of them tried to conceive. Twenty-two (44.9%) patients became pregnant; the total number of pregnancies was 30. These pregnancies resulted in seven abortions (23.3%), one pre-term birth (3.3%), and 20 full-term births (66.6%). The total live birth rate was 66.6 % (20/30). The median duration of hormonal treatment was 11.9 months (range 4-49) and 12.0 months (range 3-35) in the pregnant and non-pregnant groups, respectively. On multivariate analysis, age, body mass index, treatment duration, medroxyprogesterone dose, and number of dilatation and curettage biopsies were not significantly associated with pregnancy failure, but the association with grade (OR 6.2, 95% CI 1.0 to 38.9; P