Abstract：
OBJECTIVE: To evaluate the safety and effectiveness of high-dose oral medroxyprogesterone acetate (MPA) therapy as a fertility-sparing treatment for patients diagnosed with atypical endometrial hyperplasia (AEH) and endometrioid carcinoma G1 without myometrial invasion (G1EC). Particular attention was given to the extended administration and readministration of MPA for patients with persistent disease following initial treatment and those with recurrence.
METHODS: We conducted a retrospective analysis of data from 79 patients who underwent daily oral MPA treatment between 2005 and 2024 at Nagoya University Hospital. Patient characteristics, treatment outcomes, factors contributing to recurrence, and post-MPA therapy pregnancies were examined.
RESULTS: MPA therapy achieved a remarkable complete response (CR) rate of 91.1%. The median time to achieve CR was 26.0 and 40.0 weeks for AEH and G1EC patients, respectively. Importantly, 27 patients (39.7%) attained CR after more than 6 months of treatment, including 8 patients (11.8%) who achieved CR after more than a year of treatment. The recurrence rates were 52.9% for AEH and 64.7% for G1EC. Twenty eight patients resumed MPA treatment, and 23 achieved second CR. Notably, recurrence was not associated with clinical factors such as age, body mass index, or post-CR pregnancy. Among patients who attempted pregnancy after achieving CR, 22 live births were successfully achieved.
CONCLUSIONS: High-dose oral MPA therapy demonstrated both safety and efficacy for preserving fertility in patients with AEH and G1EC, resulting in a high CR rate. MPA extension and readministration proved to be beneficial strategies for managing patients with recurrence and persistent disease following initial treatment.
METHODS: We conducted a retrospective analysis of data from 79 patients who underwent daily oral MPA treatment between 2005 and 2024 at Nagoya University Hospital. Patient characteristics, treatment outcomes, factors contributing to recurrence, and post-MPA therapy pregnancies were examined.
RESULTS: MPA therapy achieved a remarkable complete response (CR) rate of 91.1%. The median time to achieve CR was 26.0 and 40.0 weeks for AEH and G1EC patients, respectively. Importantly, 27 patients (39.7%) attained CR after more than 6 months of treatment, including 8 patients (11.8%) who achieved CR after more than a year of treatment. The recurrence rates were 52.9% for AEH and 64.7% for G1EC. Twenty eight patients resumed MPA treatment, and 23 achieved second CR. Notably, recurrence was not associated with clinical factors such as age, body mass index, or post-CR pregnancy. Among patients who attempted pregnancy after achieving CR, 22 live births were successfully achieved.
CONCLUSIONS: High-dose oral MPA therapy demonstrated both safety and efficacy for preserving fertility in patients with AEH and G1EC, resulting in a high CR rate. MPA extension and readministration proved to be beneficial strategies for managing patients with recurrence and persistent disease following initial treatment.
摘要：
目的：评价大剂量口服醋酸甲羟孕酮（MPA）治疗不典型子宫内膜增生（AEH）和无子宫肌层浸润（G1EC）的子宫内膜样癌G1期患者作为保留生育功能的治疗方法的安全性和有效性。对于初次治疗后患有持续性疾病的患者和复发患者，应特别注意MPA的延长给药和再给药。
方法：我们对2005年至2024年间在名古屋大学医院接受每日口服MPA治疗的79例患者的数据进行了回顾性分析。患者特征,治疗结果，导致复发的因素，和MPA治疗后的妊娠进行了检查。
结果：MPA治疗取得了91.1%的显著完全缓解(CR)率。AEH和G1EC患者达到CR的中位时间分别为26.0和40.0周，分别。重要的是,27例患者（39.7%）在治疗超过6个月后达到CR，其中8例(11.8%)治疗一年以上后达到CR。AEH和G1EC的复发率分别为52.9%和64.7%。28名患者恢复MPA治疗,23人获得了第二次CR。值得注意的是,复发与年龄等临床因素无关，身体质量指数,或CR后怀孕。在达到CR后尝试怀孕的患者中，成功实现了22例活产。
结论：大剂量口服MPA治疗在AEH和G1EC患者中表现出安全性和有效性，导致高CR率。MPA的延长和再给药被证明是管理初次治疗后复发和持续性疾病患者的有益策略。
方法：我们对2005年至2024年间在名古屋大学医院接受每日口服MPA治疗的79例患者的数据进行了回顾性分析。患者特征,治疗结果，导致复发的因素，和MPA治疗后的妊娠进行了检查。
结果：MPA治疗取得了91.1%的显著完全缓解(CR)率。AEH和G1EC患者达到CR的中位时间分别为26.0和40.0周，分别。重要的是,27例患者（39.7%）在治疗超过6个月后达到CR，其中8例(11.8%)治疗一年以上后达到CR。AEH和G1EC的复发率分别为52.9%和64.7%。28名患者恢复MPA治疗,23人获得了第二次CR。值得注意的是,复发与年龄等临床因素无关，身体质量指数,或CR后怀孕。在达到CR后尝试怀孕的患者中，成功实现了22例活产。
结论：大剂量口服MPA治疗在AEH和G1EC患者中表现出安全性和有效性，导致高CR率。MPA的延长和再给药被证明是管理初次治疗后复发和持续性疾病患者的有益策略。
