| BackgroundIn China,endometrial carcinoma is the most frequent invasive malignancy tumour of the female reproductive tract.Its prevalence continues to rise with a combination of lifestyle changes.The majority of ECs are sporadic,with only 10% being familial.It is a heterogeneous group of tumors,and patients with different subtypes respond to therapy and have different outcomes.Most patients are diagnosed in postmenopausal women,and a small number are diagnosed during childbearing age.However,this minority of patients often shows a strong desire to secure their fertility.Polycystic ovary syndrome,obesity,insulin resistance,diabetes,hypertension,advanced age,race,nulliparity,early menarche,late menopause,irregular cycle,infertility,and anovulation or sparse ovulation,amenorrhea,tamoxifen use,and genetic susceptibility are all risk factors for patients with EC.The primary treatment options for EC include surgery,radiation,and chemotherapy.It is often treated by total hysterectomy(laparotomy or laparoscopy)with or without bilateral salpingo-oophorectomy and with or without lymphadenectomy.However,this leads to permanent impairment of reproductive function.Conservative treatment has been suggested as a means of delaying or preventing surgery.It is feasible and effective in young women with early endometrial cancer with grade I,stage IA,and limited to the endometrium,who need to preserve their fertility after a comprehensive examination and careful decision.Therefore,it is crucial to develop precise diagnoses,prognostic biomarkers,and innovative therapeutic alternatives for EC.Purpose of the studyCurrently,there are several reports of successful conservative treatment of endometrial cancer at home and abroad,but comparatively few reports of the inability of conservative treatment.In addition,the molecular typing of non-reproductive endometrial cancer has been reported.Our current research intends to evaluate the clinical and pathological features.In addition,it focused on the molecular subtypes of early endometrial cancer(EEC)in women of fertility age after failed conservative treatment.MethodologyIn 186 cases of women of reproductive age with endometrial cancer under 40 years old;routine hormone therapies were performed in the medical record system in the past ten years at the Second Hospital of Jilin University,Changchun,China,from January 2011 to October 2021.Overall,15 patients with EC who had failed the conservative treatments were enrolled in our retrospective study,and medical records were collected from September 2020 to March 2021.Therefore,we evaluated the outcomes of conservative treatment and the prognosis.In addition,we compared the results of a preoperative curettage biopsy to histopathological findings.Furthermore,we used next-generation sequencing(NGS)to determine the molecular categorization of all patients to find out which types of molecular endometrial carcinoma(EC)are resistant to conservative fertility management.ResultsA total of 15 patients met the criteria for G1 EC diagnosis with a median age was33.67 years,ranging from 26 to 40 years.The median age at menarche was 13.56 years,ranging from 11 to 16 years.The medium follow-up was 39 months,ranging from 13 to120 months.Among them,3 patients were single and had no history of pregnancy;the remaining 12 were married,although the majority of them(10 patients)were predominantly infertile.In total patients,3 cases were revealed recurrence,and 1 patient had shown progressive disease and underwent a hysterectomy.In addition,a hysterectomy was performed on 11 patients whose disease was stable and did not respond to progestins.Among them,1 case had intra-cervical epithelioid neoplasia,2 had PCOS,1 had liver disease,1 had hypertension,and 8 had obesity.Overall,15 patients underwent surgical intervention after conservative treatment for EC recurrence,a stable and progressive disease.In addition,during surgery,12 patients were undergo ovarian preservation.In eight of them,ovarian biopsy were conducted intraoperatively and all were negative findings.In curettage biopsies,all patients had G1 EC.In contrast to the results of the biopsy,6 of the 15 patients showed different pathological categories.In addition,the findings of molecular classification showed that 13 cases had CNL,and 2 had MSI-H.However,all patients remained infertile after conservative management.ConclusionsThe molecular classification might offer reliable information for evaluating prognosis and assist in selecting treatment approaches for EEC patients.Conservative treatment in women with EC is safe and effective but needs a careful patient selection.However,pregnancy failure after conservative management in patients with EEC remains unresolved.In addition,patients diagnosed with MSI-H are not recommended for conservative treatment.However,it is feasible to attempt for EEC individuals with CHL,as consistent follow-up is required to detect EC recurrence and prevent disease deterioration. |
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