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Abstract：
The objective of this study was to examine the current trends in fertility-sparing (FS) treatment for young atypical endometrial hyperplasia (AEH) and endometrial cancer (EC) patients in Japan.
This study was conducted by the Committee on Gynecologic Oncology of the Japan Society of Obstetrics and Gynecology (JSOG) in the 2017-2018 fiscal year. A nationwide, retrospective questionnaire-style survey-as performed. We collected the data of 413 patients from 102 JSOG gynecological cancer registered institutions.
FS treatment was performed with medroxyprogesterone (MPA) (87.2%) or MPA + metformin (11.6%). Pathological complete remission (CR) after initial treatment was achieved in 78.2% of patients. The significant clinicopathological factors correlated to CR after initial treatment were histology (AEH vs. endometrioid carcinoma grade 1 [ECG1]), body mass index (BMI) (<25 vs. ≥25 kg/m²), and treatment period (<6 vs. ≥6 months). ECG1, time to complete remission (TTCR) ≥6 months, maintenance therapy (-), and pregnancy (-) were associated with a significantly higher risk of recurrence on multivariate analysis. The total pregnancy rate was 47%, and the live birth rate was 40.1%. Patients who received infertility treatments showed a higher live birth rate (50.6%) than those who did not (7.7%).
In this survey, we confirmed that FS treatment in Japan is centered on MPA alone and in combination with metformin, and that the treatment efficacy is similar to that reported in previous reports. A multicenter survey study in Japan showed FS treatment for young AEH and EC patients in compliance with the indications is feasible.
This study was conducted by the Committee on Gynecologic Oncology of the Japan Society of Obstetrics and Gynecology (JSOG) in the 2017-2018 fiscal year. A nationwide, retrospective questionnaire-style survey-as performed. We collected the data of 413 patients from 102 JSOG gynecological cancer registered institutions.
FS treatment was performed with medroxyprogesterone (MPA) (87.2%) or MPA + metformin (11.6%). Pathological complete remission (CR) after initial treatment was achieved in 78.2% of patients. The significant clinicopathological factors correlated to CR after initial treatment were histology (AEH vs. endometrioid carcinoma grade 1 [ECG1]), body mass index (BMI) (<25 vs. ≥25 kg/m²), and treatment period (<6 vs. ≥6 months). ECG1, time to complete remission (TTCR) ≥6 months, maintenance therapy (-), and pregnancy (-) were associated with a significantly higher risk of recurrence on multivariate analysis. The total pregnancy rate was 47%, and the live birth rate was 40.1%. Patients who received infertility treatments showed a higher live birth rate (50.6%) than those who did not (7.7%).
In this survey, we confirmed that FS treatment in Japan is centered on MPA alone and in combination with metformin, and that the treatment efficacy is similar to that reported in previous reports. A multicenter survey study in Japan showed FS treatment for young AEH and EC patients in compliance with the indications is feasible.
摘要：
目的：本研究的目的是研究日本年轻的非典型子宫内膜增生（AEH）和子宫内膜癌（EC）患者保留生育能力（FS）治疗的当前趋势。
方法：本研究由日本妇产科学会（JSOG）妇科肿瘤学委员会在2017-2018财年进行。一个全国性的,回顾性问卷调查式调查。我们收集了来自102个JSOG妇科癌症注册机构的413名患者的数据。
结果：FS治疗采用甲羟孕酮（MPA）（87.2%）或MPA+二甲双胍（11.6%）。78.2％的患者在初始治疗后实现了病理完全缓解（CR）。初始治疗后与CR相关的重要临床病理因素是组织学（AEH与1级子宫内膜样癌[ECG1]），体重指数（BMI）（<25vs.≥25千克/平方米)，和治疗期（<6vs）≥6个月）。ECG1，完全缓解时间（TTCR）≥6个月，维持治疗（-），在多变量分析中,妊娠(-)与显著较高的复发风险相关.总妊娠率为47%,活产率为24%。接受不孕症治疗的患者的活产率（50.6％）高于未接受治疗的患者（7）7％。
结论：在这项调查中，我们证实，日本的FS治疗主要集中在MPA单独治疗和二甲双胍联合治疗，治疗效果与以前报道的相似。在日本进行的一项多中心调查研究表明，符合适应症的年轻AEH和EC患者的FS治疗是可行的。
方法：本研究由日本妇产科学会（JSOG）妇科肿瘤学委员会在2017-2018财年进行。一个全国性的,回顾性问卷调查式调查。我们收集了来自102个JSOG妇科癌症注册机构的413名患者的数据。
结果：FS治疗采用甲羟孕酮（MPA）（87.2%）或MPA+二甲双胍（11.6%）。78.2％的患者在初始治疗后实现了病理完全缓解（CR）。初始治疗后与CR相关的重要临床病理因素是组织学（AEH与1级子宫内膜样癌[ECG1]），体重指数（BMI）（<25vs.≥25千克/平方米)，和治疗期（<6vs）≥6个月）。ECG1，完全缓解时间（TTCR）≥6个月，维持治疗（-），在多变量分析中,妊娠(-)与显著较高的复发风险相关.总妊娠率为47%,活产率为24%。接受不孕症治疗的患者的活产率（50.6％）高于未接受治疗的患者（7）7％。
结论：在这项调查中，我们证实，日本的FS治疗主要集中在MPA单独治疗和二甲双胍联合治疗，治疗效果与以前报道的相似。在日本进行的一项多中心调查研究表明，符合适应症的年轻AEH和EC患者的FS治疗是可行的。
