Fertility-preserving treatment with progestin, and pathological criteria to predict responses, in young women with endometrial cancer
Fertility-preserving treatment with progestin, and pathological criteria to predict responses, in young women with endometrial cancer
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DOI：
10.1093/humrep/dem088
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发表时间：
2007-07-01
影响因子：
6.1
通讯作者：
Isaka, Keiichi
中科院分区：
文献类型：
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作者：
Yamazawa, Koji;Hirai, Makiko;Isaka, Keiichi
背景：年轻女性子宫内膜癌的保守治疗存在着两难的选择。方法：我们计划进行一项前瞻性研究，从1999年至2005年保守治疗40岁以下临床分期为1A、1级乳腺样腺癌的女性患者。有9名妇女（年龄28-40岁）符合标准，醋酸甲羟孕酮（400毫克/天）持续6个月。根据我们的标准对刮除材料进行病理学评价，包括部分缓解（PR）（少量癌组织具有显著的激素效应或非典型增生）。为了预测对曲马多蛋白的完全反应（CR），评估了胰岛素样生长因子1型受体、10号染色体上缺失的磷酸酶和张力蛋白同源物、孕酮受体（PgR）、雌激素受体和Ki 67的免疫组织化学染色。结果：分别有7例（78%）和2例完全缓解和PR。两名患者在最后一次刮宫术后10个月和22个月复发，并且都患有同步性卵巢癌。然而，所有9名患者均存活，平均39个月无疾病。在8名已婚患者中，4名（50%）妊娠，3名分娩足月单胎。CR与PgR阳性表达有关（P = 0.008）。结论：初始PR患者在进一步治疗后可获得CR，PgR可能有助于预测保留生育能力的CR。年轻女性子宫内膜癌的治疗。
BACKGROUND: There are therapeutic dilemmas regarding conservative management of endometrial cancer in young women. METHODS: We planned a prospective study to conservatively treat women aged under 40 years with clinical stage 1A, grade 1 endometrioid adenocarcinoma from 1999 to 2005. There were nine women (aged 28-40) who fulfilled the criteria, and medroxyprogesterone acetate (400 mg/day) was continued for 6 months. Curettage materials were pathologically evaluated according to our criteria including partial response (PR) (a small amount of cancer tissue with remarkable hormonal effects or atypical hyperplasia). To predict complete response (CR) to progestin, immunohistochemical staining for insulin-like growth factor type 1 receptor, phosphatase and tensin homolog deleted on chromosome ten, progesterone receptor (PgR), estrogen receptor and Ki67 were assessed. RESULTS: Seven (78%) and two cases presented complete and PRs, respectively. Two patients developed recurrent disease 10 and 22 months after the last dilatation and curettage, and both had synchronous ovarian cancer. However, all nine patients were alive and disease-free for a mean of 39 months. Of eight married patients, four (50%) conceived and three delivered full-term singletons. CR was related to positive expression of PgR (P = 0.008). CONCLUSIONS: Patients with an initial PR can obtain CR after further treatment, and the PgR may be useful in predicting CR to fertility-preserving. treatment in young women with endometrial cancer.