Effectiveness Analysis And Pregnancy Outcome Of Fertility Preservation Therapy In Patients With Endometrial Atypical Hyperplasia And Early Endometrial Cancer

ObjectiveTo Analyze the Curative Effect,Prognosis and Pregnancy Outcome of Fertility Preservation Therapy for Patients with Endometrial Atypical Hyperplasia and Early Endometrial Cancer.MethodsA Total of 105 Patients with Endometrial Atypical Hyperplasia and Early Endometrial Cancer Diagnosed by the Department of Obstetrics and Gynecology of Shenzhen Hospital of Peking University from January 1,2017 to September 30,2021,Who Strongly Requested Fertility Preservation Treatment,Including 91 Patients with Endometrial Atypical Hyperplasia(EAH Group)and 14 Patients with Early Endometrial Cancer(EEC Group);The Clinical Data of 105 Patients and the Related Conditions after Follow-up Treatment were Collected and Analyzed Retrospectively.ResultsThe Complete Response Rate of Patients with Endometrial Atypical Hyperplasia(85/91)was 93.4%,and That of Patients with Endometrial Cancer(14/14)was 100.0%.In the EAH Group,13 Patients had Recurrence in the Follow-up Observation after Complete Response,the Recurrence Rate was(13/85)15.2%,of Which 9 Patients Requested to Continue to Receive Hormone Fertility Preservation Treatment,9 Patients Achieved Complete Remission,the Complete Remission Rate was 100%,and the Other 4 Patients Underwent Total Hysterectomy.Of the 14 EEC Patients who Achieved Complete Remission,3 Patients Recurred During Follow-up,with a Recurrence Rate of(3/14)21.4%.The Recurrence Rate of ECC Group was(21.4%)Higher Than that of EAH Group(15.2%),and the Difference was Statistically Significant(P<0.5).According to the Logistic Multiple Factor Regression Analysis,the Pregnancy Rate of Patients Without Insulin Resistance(31.71%)was Higher Than that of Patients with Insulin Resistance(20.45%),and the Pregnancy Rate of Patients with Initial Diagnosis Age<35 years old(31.15%)was Higher Than that of Patients with Initial Diagnosis Age≥35 years old(12.50%),But There was No Significant Difference Between the Two Groups(P>0.5).As of the Follow-up Time,There were 30 Cases of Successful Pregnancy and 23 Cases of Live Labor in the Two Groups.In the EAH Group,16 Patients Delivered Successfully.The Live Rate of ART Group(78.6%)was Higher Than that of Natural Pregnancy Group(62.5%),But There was No Statistical Difference(P>0.05).In EEC Group,7 Cases were Delivered Successfully.The Live Rate of ART Group(85.7%)was Lower Than that of Natural Pregnancy Group(100.0%),but There was No Statistical Difference(P>0.05).ConclusionThe Patients with Early Endometrioid well-differentiated Adenocarcinoma and Endometrial Atypical Hyperplasia Can Obtain High Complete Response Rate By Oral Megestrol Acetate Treatment.For Patients Who have Relapsed after Complete Response,Satisfactory Results can Still be Obtained after Reevaluation and Fertility Preservation Treatment.The Recurrence Rate of the Early Endometrial Cancer Group after Remission is Higher Than that of the Endometrial Atypical Hyperplasia Group,Which Reminds Clinicians to be More Cautious in the Conservative Treatment of Patients with Early Endometrial Cancer.During the Follow-up Process,Long-term Management of Progesterone should be Done Well,Regular Evaluation and Close Monitoring should be Carried Out.For Patients with Complete Response After Conservative Treatment,Pregnancy should be Carried Out As Soon As Possible after Complete Response to Prevent Recurrence and Prevent Further Disease Progression.