PDF(Pubmed)
Abstract：
Objectives: To evaluate the efficacy and safety of gonadotropin-releasing hormone (GnRH) agonist after endometrial resection in women suffering early stage endometrial carcinoma (EC) and/or endometrial intra-epithelial neoplasia (EIN). Design: A retrospective review of clinical files between January 1999 and December 2016. Setting: University hospital. Patients: Eighteen women younger than 41 years with grade 1 endometrial carcinoma (G1EC) and/or Endometrial intra-epithelial neoplasia (EIN).
METHODS: All patients received GnRH agonist for 3 months after an endometrial resection combined with a laparoscopy to exclude concomitant ovarian tumor and/or other extra-uterine disease. The patient underwent a follow-up of 3 months interval with endometrial sampling by hysteroscopy. Main Outcome Measure(s): The recurrence rate and the pregnancy rate after fertility sparing treatment. Results: We identified 9 patients with EIN (50%), 7 patients with G1EC (38.9%), 1 with combined histology (5.5%), and 1 with G2EC (5.5%). After a median follow-up of 40.7 months, 12 patients conserved their uterus (66.7%), and 8 (53.3%) patients were pregnant with a total of 14 pregnancies among those who tried to become pregnant. We observed a complete response rate in 12 patients (66.7%) but 3 of these patients relapsed (25%). We also found a stable disease in 6 patients (33.3%). Conclusions: Compared with other fertility sparing treatments, GnRH agonist after surgery is an effective fertility-sparing strategy for women with EIN and/or G1EC. We recommend hysterectomy once a family has been completed even if the literature does not clearly lead to radical surgery.
METHODS: All patients received GnRH agonist for 3 months after an endometrial resection combined with a laparoscopy to exclude concomitant ovarian tumor and/or other extra-uterine disease. The patient underwent a follow-up of 3 months interval with endometrial sampling by hysteroscopy. Main Outcome Measure(s): The recurrence rate and the pregnancy rate after fertility sparing treatment. Results: We identified 9 patients with EIN (50%), 7 patients with G1EC (38.9%), 1 with combined histology (5.5%), and 1 with G2EC (5.5%). After a median follow-up of 40.7 months, 12 patients conserved their uterus (66.7%), and 8 (53.3%) patients were pregnant with a total of 14 pregnancies among those who tried to become pregnant. We observed a complete response rate in 12 patients (66.7%) but 3 of these patients relapsed (25%). We also found a stable disease in 6 patients (33.3%). Conclusions: Compared with other fertility sparing treatments, GnRH agonist after surgery is an effective fertility-sparing strategy for women with EIN and/or G1EC. We recommend hysterectomy once a family has been completed even if the literature does not clearly lead to radical surgery.
摘要：
目的：评估促性腺激素释放激素（GnRH）激动剂在子宫内膜切除术后对早期子宫内膜癌（EC）和/或子宫内膜上皮内瘤变（EIN）妇女的疗效和安全性。设计：对1999年1月至2016年12月之间的临床文件进行回顾性审查。地点：大学医院。患者：18名年龄小于41岁的女性，患有1级子宫内膜癌（G1EC）和/或子宫内膜上皮内瘤变（EIN）。
方法：所有患者在子宫内膜切除术联合腹腔镜检查后接受GnRH激动剂3个月，以排除伴随的卵巢肿瘤和/或其他子宫外疾病。患者接受了为期3个月的随访，并通过宫腔镜进行子宫内膜采样。主要结果指标：保留生育能力治疗后的复发率和妊娠率。结果：我们确定了9例EIN患者（50％），G1EC患者7例（38.9%），合并组织学1例（5.5％），1与G2EC（5.5%）。经过40.7个月的中位随访，12例患者保留子宫（66.7%），8例(53.3%)患者怀孕，试图怀孕的患者中共有14例怀孕。我们观察到12名患者（66.7％）的完全缓解率，但其中3名患者复发（25％）。我们还发现6例患者（33.3％）病情稳定。结论:与其他保留生育的治疗方法相比,手术后GnRH激动剂是EIN和/或G1EC女性的有效生育策略。即使文献没有明确导致根治性手术，我们也建议在家庭完成后进行子宫切除术。
方法：所有患者在子宫内膜切除术联合腹腔镜检查后接受GnRH激动剂3个月，以排除伴随的卵巢肿瘤和/或其他子宫外疾病。患者接受了为期3个月的随访，并通过宫腔镜进行子宫内膜采样。主要结果指标：保留生育能力治疗后的复发率和妊娠率。结果：我们确定了9例EIN患者（50％），G1EC患者7例（38.9%），合并组织学1例（5.5％），1与G2EC（5.5%）。经过40.7个月的中位随访，12例患者保留子宫（66.7%），8例(53.3%)患者怀孕，试图怀孕的患者中共有14例怀孕。我们观察到12名患者（66.7％）的完全缓解率，但其中3名患者复发（25％）。我们还发现6例患者（33.3％）病情稳定。结论:与其他保留生育的治疗方法相比,手术后GnRH激动剂是EIN和/或G1EC女性的有效生育策略。即使文献没有明确导致根治性手术，我们也建议在家庭完成后进行子宫切除术。
