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Journal of Peking University (Health Sciences) ›› 2022, Vol. 54 ›› Issue (5): 936-942. doi: 10.19723/j.issn.1671-167X.2022.05.021

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Clinical analysis of fertility-sparing therapy of patients with complex atypical hyperplasia and endometrial cancer

Chieko MORIMOTO,Yi-qin WANG,Rong ZHOU,Jian-liu WANG*()   

  1. Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China
  • Received:2022-06-15 Online:2022-10-18 Published:2022-10-14
  • Contact: Jian-liu WANG E-mail:wangjianliu@pkuph.edu.cn
  • Supported by:
    the National Key Technology Research and Development Program of China(2019YFC1005200);the National Key Technology Research and Development Program of China(2019YFC1005204)

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Abstract:

Objective: To analyze the efficacy and prognosis of fertility-sparing therapy of the patient with complex atypical hyperplasia (CAH) and endometrial cancer (EC). Methods: Clinical data of 191 EC and CAH patients who received fertility-sparing therapy in Peking University People's Hospital between January 2009 and September 2021 were recruited retrospectively. Outcomes of remission, recurrence and pregnancy were analyzed. Results: (1) Efficacy and efficacy-related factors: The complete response (CR) rate was 86.1% (161/187) for all the patients, and the CR rate of the CAH patients were higher than that of the EC patients (92.7% vs. 79.1%, P=0.007), the CR rate was significant higher in the CAH patients (OR=2.786, P=0.035). (2) The recurrence rate was 19.3% (31/161), and the recurrence rate of the EC patients were much higher than that of the CAH patients (26.4% vs. 13.5%, P=0.039). The median recurrence time was 22.5 (9.0, 50.0) months. (3) The high risk factors of recurrence were pathological type of EC (χ2=4.880, P=0.027), without the use of metfor-min (χ2=7.075, P=0.008), longer time to complete remission (>7 months) (χ2=6.204, P=0.013), and no pregnancy (χ2=6.765, P=0.009). (4) Results of pregnancy and related factors: Among the patients who achieved CR, 108 patients had fertility willing with the pregnancy rate of 41.7% (45/108), and the live birth rate was 34.3% (37/108). The live birth rate was lower in EC than that in the CAH patients (28.6% vs. 42.4%, P=0.045). The median time to achieve pregnancy was 10.50 (5.75, 33.25) months. The pregnancy rate was significant higher in the patients with pregnancy history (OR=9.468, P < 0.001) and in those who received assisted reproductive therapy (OR=7.809, P < 0.001). Conclusion: Fertility-sparing therapy of CAH and EC patients is effective resulting in high disease remission and certain pregnancy. However, the high recurrence rate and low pregnancy rate are still key problems for EC and CAH patients, therefore close monitoring and follow-up are indicated.

Key words: Complex atypical hyperplasia, Endometrial carcinoma, Fertility preservation, Recurrence, Pregnancy

CLC Number: 

  • R737.33

Table 1

General condition of 191 EC and CAH patients"

Items Total (n=191) EC (n=92) CAH (n=99) P value
Age/years 33.0±5.7 32.5±5.4 33.4±5.9 0.244
Number of times of pregnancy
  0 121 (63.4) 59 (64.1) 62 (62.6) 0.829
  ≥1 70 (36.6) 33 (35.9) 37 (37.4)
Number of times of delivery
  0 157 (82.2) 78 (84.8) 79 (79.8) 0.368
  ≥1 34 (17.8) 14 (15.2) 20 (20.2)
BMI/(kg/m 2) 27.5±5.1 27.5±5.2 27.6±5.1 0.973
Complications
  Type Ⅱ diabetes 22 (11.5) 12 (13.0) 10 (10.1) 0.524
  PCOS 23 (12.0) 11 (12.0) 12 (12.1) 0.972
  Thyroid disease 11 (5.8) 6 (0.7) 5 (0.5) 0.663

Table 2

Logistic regression analysis of efficacy-related factors in 187 patients undergoing fertility-sparing therapy"

Items One factor analysis Multiple factors analysis
OR (95% CI) P value OR (95% CI) P value
Age/years ≥30 1.833 (0.653-5.147) 0.25 2.256 (0.717-7.100) 0.164
< 30 1 1
BMI/(kg/m2) ≥25 1.774 (0.664-4.738) 0.253 1.729 (0.631-4.733) 0.287
< 25 1 1
Pathology CAH 3.355 (1.336-8.424) 0.01 2.786 (1.073-7.235) 0.035
EC 1 1
Complication with PCOS Yes 0.588 (0.129-2.677) 0.492
No 1
Complication with diabetes Yes 1.036 (0.283-3.799) 0.957
No 1
Types of progesterone MPA 0.916 (0.194-4.330) 0.912
MA 1
Using metformin Yes 1.361 (0.582-3.180) 0.477
No 1

Figure 1

Kaplan-Meier cumulative complete response rate curve of fertility-sparing therapy for different pathological types EC, endometrial cancer; CAH, complex atypical hyperplasia."

Table 3

Logistic regression analysis of recurrence-related factors in patients with fertility-sparing therapy"

Items One factor analysis Multiple factors analysis
OR (95% CI) P value OR (95% CI) P value
Age/years ≥30 0.844 (0.361-1.973) 0.696
< 30 1
BMI/(kg/m2) ≥25 0.960 (0.416-2.218) 0.924
< 25 1
Pathology CAH 2.300 (1.031-5.134) 0.042 1.779 (0.729-4.343) 0.206
EC 1 1
Complication with PCOS Yes 0.712 (0.195-2.601) 0.608
No 1
Complication with diabetes Yes 0.821 (0.222-3.034) 0.768
No 1
Complication with thyroid disease Yes 0.689 (0.080-5.939) 0.735
No 1
Types of progesterone MPA 2.800 (0.845-9.283) 0.092 2.288 (0.653-8.014) 0.196
MA 1 1
Using metformin Yes 2.036 (0.890-4.660) 0.092 1.662 (0.691-3.994) 0.256
No 1 1
Using GnRHa Yes 1.960 (0.870-4.415) 0.104 1.667 (0.675-4.117) 0.268
No 1 1
Maintenance treatment Yes 0.734 (0.297-1.812) 0.502
No 1
Pregnancy Yes 1.024 (0.358-2.933) 0.964
No 1
Delivery Yes 2.13 (0.333-13.666) 0.424
No 1

Figure 2

Kaplan-Meier curve of cumulative recurrence rate for EC and CAH patients A, pathology; B, combination with metformin; C, with treatment time to complete response more than 7 months or not; D, with or without pregnancy. EC, endometrial cancer; CAH, complex atypical hyperplasia."

Table 4

Pregnancy status of 108 patients with fertility intention after achieving complete remission with the conservative treatment"

Items Total CAH (n=89) EC (n=72) P value
Patients with fertility intention 108 59 49
Patients with assisted human reproduction 34 19 15
Patients with pregnancy (pregnancy times) 45 (50) 26 (29) 19 (21)
Patients with delivery (delivery times) 39 (37) 27 (25) 12 (12)
Pregnancy rate/% 41.7 44.1 38.8 0.579
Fertility rate/% 34.3 42.4 28.6 0.045
Pregnancy duration/months, M (P25, P75) 10.50 (5.75, 33.25) 9.00 (2.50, 29.50) 13.00 (7.00, 46.50) 0.196

Table 5

Logistic regression analysis of pregnancy-related factors of the 108 patients with fertility intention"

Items One factor analysis Multiple factors analysis
OR (95% CI) P value OR (95% CI) P value
Age/years ≥30 0.773 (0.338-1.772) 0.543
< 30 1
Pregnancy history Yes 10.711 (4.206-27.271) < 0.001 9.468 (2.928-30.618) < 0.001
No 1 1
BMI/(kg/m2) ≥25 0.731 (0.324-1.647) 0.45
< 25 1
Complication with PCOS Yes 2.508 (0.762-8.253) 0.13 2.209 (0.374-13.046) 0.382
No 1 1
Complication with diabetes Yes 0.247 (0.051-1.186) 0.081 0.627 (0.061-6.432) 0.695
No 1 1
Complication with thyroid disease Yes 0.999
No
Pathology CAH 0.804 (0.372-1.738) 0.579
EC 1
Using metformin Yes 0.822 (0.379-1.785) 0.621
No 1
Using GnRHa Yes 1.099 (0.469-2.576) 0.828
No 1
Assisted human reproduction Yes 12.768 (4.763-34.244) < 0.001 7.809 (2.600-23.457) < 0.001
No 1
Recurrence Yes 1.024 (0.358-2.933) 0.964
No 1
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