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Abstract：
OBJECTIVE: This study aimed to evaluate the oncological and reproductive outcomes of fertility-preserving re-treatment in progestin-resistant endometrial carcinoma (EC) and atypical endometrial hyperplasia (AEH) women who desire to maintain their fertility.
METHODS: Our study included 61 progestin-resistant EC/AEH patients. These patients underwent treatment with gonadotropin-releasing hormone agonist (GnRHa) solely or a combination of GnRHa with levonorgestrel-releasing intrauterine system (LNG-IUD) or aromatase inhibitor (AI). Histological evaluations were performed every 3-4 months. Upon achieving complete remission (CR), we recommended maintenance treatments including LNG-IUD, cyclical oral contraceptives, or low-dose cyclic progestin until they began attempting conception. Regular follow-up was conducted for all patients. The chi-square method was utilized to compare oncological and fertility outcomes, while the Cox proportional hazards regression analysis helped identify risk factors for CR, recurrence, and pregnancy.
RESULTS: Overall, 55 (90.2%) patients achieved CR, including 90.9% of AEH patients and 89.7% of EC patients. The median re-treatment time was 6 months (ranging from 3 to 12 months). The CR rate for GnRHa alone, GnRHa + LNG-IUD and GnRHa + AI were 80.0%, 91.7% and 93.3%, respectively. After a median follow-up period of 36 months (ranging from 3 to 96 months), 19 women (34.5%) experienced recurrence, 40.0% in AEH and 31.4% in EC patients, with the median recurrence time of 23 months (ranging from 6 to 77 months). Among the patients who achieved CR, 39 expressed a desire to conceive, 20 (51.3%) became pregnant, 11 (28.2%) had successfully deliveries, 1 (5.1%) was still pregnant, while 8 (20.5%) suffered miscarriages.
CONCLUSIONS: GnRHa-based fertility-sparing treatment exhibited promising oncological and reproductive outcomes for progestin-resistant patients. Future larger multi-institutional studies are necessary to confirm these findings.
METHODS: Our study included 61 progestin-resistant EC/AEH patients. These patients underwent treatment with gonadotropin-releasing hormone agonist (GnRHa) solely or a combination of GnRHa with levonorgestrel-releasing intrauterine system (LNG-IUD) or aromatase inhibitor (AI). Histological evaluations were performed every 3-4 months. Upon achieving complete remission (CR), we recommended maintenance treatments including LNG-IUD, cyclical oral contraceptives, or low-dose cyclic progestin until they began attempting conception. Regular follow-up was conducted for all patients. The chi-square method was utilized to compare oncological and fertility outcomes, while the Cox proportional hazards regression analysis helped identify risk factors for CR, recurrence, and pregnancy.
RESULTS: Overall, 55 (90.2%) patients achieved CR, including 90.9% of AEH patients and 89.7% of EC patients. The median re-treatment time was 6 months (ranging from 3 to 12 months). The CR rate for GnRHa alone, GnRHa + LNG-IUD and GnRHa + AI were 80.0%, 91.7% and 93.3%, respectively. After a median follow-up period of 36 months (ranging from 3 to 96 months), 19 women (34.5%) experienced recurrence, 40.0% in AEH and 31.4% in EC patients, with the median recurrence time of 23 months (ranging from 6 to 77 months). Among the patients who achieved CR, 39 expressed a desire to conceive, 20 (51.3%) became pregnant, 11 (28.2%) had successfully deliveries, 1 (5.1%) was still pregnant, while 8 (20.5%) suffered miscarriages.
CONCLUSIONS: GnRHa-based fertility-sparing treatment exhibited promising oncological and reproductive outcomes for progestin-resistant patients. Future larger multi-institutional studies are necessary to confirm these findings.
摘要：
目的：本研究旨在评估孕激素耐药的子宫内膜癌（EC）和不典型子宫内膜增生（AEH）妇女的肿瘤和生殖结局。
方法：我们的研究包括61例孕激素耐药的EC/AEH患者。这些患者仅接受促性腺激素释放激素激动剂（GnRHa）或GnRHa与左炔诺孕酮宫内释放系统（LNG-IUD）或芳香化酶抑制剂（AI）的组合治疗。每3-4个月进行组织学评价。在达到完全缓解（CR）后，我们建议进行维护处理，包括LNG-IUD，周期性口服避孕药，或低剂量循环孕激素，直到他们开始尝试受孕。对所有患者进行定期随访。卡方方法用于比较肿瘤和生育结果，虽然Cox比例风险回归分析有助于识别CR的危险因素，复发,和怀孕。
结果：总体而言，55例（90.2%）患者达到CR，包括90.9%的AEH患者和89.7%的EC患者。中位再治疗时间为6个月(3~12个月)。单独GnRHa的CR率，GnRHa+LNG-IUD和GnRHa+AI分别为80.0%,91.7%和93.3%，分别。经过36个月的中位随访期（3至96个月），19名女性(34.5%)复发，AEH患者为40.0%，EC患者为31.4%，中位复发时间为23个月（6至77个月）。在获得CR的患者中，39表达了怀孕的愿望，20人（51.3%）怀孕，11人(28.2%)成功交付，1名（5.1％）仍在怀孕，8人(20.5%)流产。
结论：基于GnRHa的生育保留治疗对孕激素耐药患者具有良好的肿瘤和生殖结局。未来更大的多机构研究有必要证实这些发现。
方法：我们的研究包括61例孕激素耐药的EC/AEH患者。这些患者仅接受促性腺激素释放激素激动剂（GnRHa）或GnRHa与左炔诺孕酮宫内释放系统（LNG-IUD）或芳香化酶抑制剂（AI）的组合治疗。每3-4个月进行组织学评价。在达到完全缓解（CR）后，我们建议进行维护处理，包括LNG-IUD，周期性口服避孕药，或低剂量循环孕激素，直到他们开始尝试受孕。对所有患者进行定期随访。卡方方法用于比较肿瘤和生育结果，虽然Cox比例风险回归分析有助于识别CR的危险因素，复发,和怀孕。
结果：总体而言，55例（90.2%）患者达到CR，包括90.9%的AEH患者和89.7%的EC患者。中位再治疗时间为6个月(3~12个月)。单独GnRHa的CR率，GnRHa+LNG-IUD和GnRHa+AI分别为80.0%,91.7%和93.3%，分别。经过36个月的中位随访期（3至96个月），19名女性(34.5%)复发，AEH患者为40.0%，EC患者为31.4%，中位复发时间为23个月（6至77个月）。在获得CR的患者中，39表达了怀孕的愿望，20人（51.3%）怀孕，11人(28.2%)成功交付，1名（5.1％）仍在怀孕，8人(20.5%)流产。
结论：基于GnRHa的生育保留治疗对孕激素耐药患者具有良好的肿瘤和生殖结局。未来更大的多机构研究有必要证实这些发现。
