子宫内膜子宫内膜样癌(EEC)的发病率在过去十年中逐渐增加。孕激素保留生育力疗法是EEC或子宫内膜非典型增生(AH)的治疗选择。本研究评估了保留生育力治疗EEC或AH后许多预后因素的作用。此外,本研究评估了各种临床病理指标对治疗效果的预测价值.回顾性分析2013年8月至2021年9月在北京大学人民医院(北京,中国)。在治疗3个月后和保留生育力治疗结束时,从每位患者获得子宫内膜标本。治疗前采用χ2检验评价疗效及预后。此外,EEC生物标志物的蛋白质表达水平,如雌激素受体(ER),孕激素受体(PR),配对盒子2(PAX2),使用免疫组织化学评估PTEN和p53。EEC组保留生育力治疗的总完全缓解率(CR)为67.39%(31/46),而AH组为86.49%(32/37)。EEC组和AH组的CR率差异有统计学意义(P<0.05)。治疗后的预后与ER无相关性,在最初未处理的AH或EEC组中PAX2、PTEN或Ki-67表达。然而,在EEC和AH组中,与PR表达≤50%的组织相比,PR表达>50%的组织具有更高的CR率.此外,在EEC患者中,PAX2阳性组的CR率高于PAX2阴性组.总之,这些数据表明,对于希望在治疗后保持生育能力的EEC和AH患者,保留生育能力的治疗是有效的.具体来说,在AH组中,较高比例的患者达到CR,同时也更快地达到CR。此外,PR被证明是评估EEC和AH的有用标记。
The incidence of endometrial endometrioid carcinoma (EEC) has been gradually increasing over the past decade. Fertility-sparing therapy with progestin is a treatment option for EEC or endometrial atypical hyperplasia (AH). The present study evaluated the role of numerous prognostic factors following fertility-sparing therapy for EEC or AH. Furthermore, the present study assessed the strength of various clinicopathological indicators for the prediction of treatment efficacy. A retrospective analysis was performed of patients with EEC and AH who received fertility-sparing therapy between August 2013 and September 2021 at Peking University People\'s Hospital (Beijing,
China). Endometrial specimens were obtained from each patient after 3 months of treatment and at the end of the fertility-sparing therapy, before treatment efficacy and prognosis were evaluated using the χ2 test. Furthermore, the protein expression levels of EEC biomarkers, such as estrogen receptor (ER), progesterone receptor (PR), paired box 2 (PAX2), PTEN and p53 were assessed using immunohistochemistry. The overall complete response (CR) rate of fertility-sparing treatment in the EEC group was 67.39% (31/46), whereas that in the AH group was 86.49% (32/37). The difference between the CR rates in the EEC and AH groups was statistically significant (P<0.05). There was no association between prognosis after treatment and ER, PAX2, PTEN or Ki-67 expression in the initially untreated AH or EEC groups. However, tissues with >50% positive PR expression were demonstrated to have a higher CR rate compared with those with ≤50% positive PR expression in both the EEC and AH groups. Furthermore, the PAX2-positive group tended to demonstrate higher CR rates compared with the PAX2-negative group in the patients with EEC. In conclusion, these data suggested that fertility-sparing therapy is effective for patients with EEC and AH who wish to remain fertile after treatment. Specifically, in the AH group, a higher proportion of patients achieved a CR whilst also achieving this more rapidly. Furthermore, PR was demonstrated to be a useful marker for the evaluation of EEC and AH.