| Objective:To evaluate the efficacy and safety of fertility preservation therapy by analyzing the clinical data of oral progestin combined with hysteroscopic resection in the treatment of early endometrial cancer(EEC)and endometrial atypical hyperplasia.(EAH).and to explore the relevant factors affecting its efficacy and prognosis,so as to provide reference for the selection of conservation and treatment of early endometrial carcinoma and its precancerous lesions.Methods:From January 2016 to January 2019,43 patients with early endometrial cancer and endometrial atypical hyperplasia(26 cases of stage IA highly differentiated endometrial adenocarcinoma,17 cases of endometrial atypical hyperplasia)were selected from Yunnan cancer hospital.All patients who had a strong desire to retain reproductive function,met the inclusion criteria,informed about the risks of conservative treatment and signed informed consent were included in the retrospective study.After admission,all patients were assessed by hysteroscopy(localized and diffuse type),local lesions were removed or resected(with suspected myometrial infiltration),and oral megestrol was 160mg/day;diffuse lesions were assessed by hysteroscopy every 3 months,If it is observed that the focus changes from diffuse type to focal type,the focus can be removed by hysteroscopy or electrotomy(in case of suspected myometrial infiltration),the timing of resection should be selected according to the morphological characteristics of the focus under hysteroscopy,and progesterone treatment should be continued after resection.After complete remission,if there is pregnancy planning,it is suggested to consult reproductive heritage experts for pregnancy preparation guidance after the pathological results are negative twice;if there is no pregnancy planning in a short period,LNG-IUS should be placed.For women who do not respond to treatment,have partial remission or relapse within 12 months,surgical removal of bilateral uterine appendages is recommended as the final treatment.The clinical,pathological and follow-up data of all patients were collected,and the pregnancy outcome was taken as the end point to observe the curative effect and prognosis,and the relevant factors affecting complete remission and recurrence were analyzed.Results:1.Overall efficacy:41 patients(95.3%)showed complete remission(CR)(time range:3～33 months),including 25 patients with EEC and 16 patients with eah.35 cases(81.4%)had complete remission within 12 months.The average treatment time to achieve CR was(6.3±0.8)months,and 6 cases had complete remission for more than 12 months.Two patients were in the state of disease persistence and had no response to the treatment up to now(time range 12～63 months).Among the patients with complete remission,8(19.5%)had relapse(recurrence time:6～27 months),5 of them recurred during ovulation induction treatment,and 3 of them did not put LNG-IUS for maintenance treatment after reaching Cr;6 of the recurred patients achieved complete remission(time range:3～12 months)after re nursing treatment,and 2 of the recurred patients underwent staged operation(postoperative pathology)In stage IA,G1 endometrial adenocarcinoma with infiltration of less than 1/2 of myometrium;in stage IA,G1 endometrial adenocarcinoma without infiltration of myometrium).Nine patients had no family planning for a short period of time due to personal reasons,such as economic problems,male infertility,divorce,family or work problems,and others chose to adopt.A total of 32 patients had fertility desire.17 patients received reproductive intervention(5 EAH,12 EEC),6(35.2%)patients were pregnant and gave birth(4 EAH,2 EEC),3 were natural conception,3 were pregnant after the treatment of assisted reproductive technology,1 patient was pregnant and gave birth successfully after the treatment of assisted reproductive technology,1 year later,natural conception and gave birth,6 patients were all tumor free.2.Complete remission related factor analysis:single factor analysis showed that BMI,previous medical history,lesion size and complete remission rate were significantly different(P<0.05).The complete remission time of patients with BMI<25 kg/m2 was shorter than that of patients with BMI≥25 kg/m2(P<0.05).The remission time of patients with PCOS was longer than that of patients without previous history,and that of patients with PCOS was longer than that of patients with infertility(P<0.05).Multivariate analysis showed that patients with BMI<25 kg/m2 had a higher probability of remission(HR=0.296;95%CI,0.123-0.710;P=0.006),which was a protective factor.3.Recurrence related factor analysis:single factor analysis showed that BMI,hormone type(maintenance treatment or not),and the recurrence rate of ovulation induction were significantly different(P<0.05).The recurrence time of patients with BMI<25 kg/m2 was significantly later than that of patients with BMI≥25 kg/m2(P<0.001).The recurrence time of patients with oral progesterone was significantly earlier than that of patients with oral progesterone+LNG-IUS(P<0.001).The recurrence time of patients with ovulation induction was significantly earlier than that of patients without ovulation induction(P<0.05).Multivariate analysis showed that patients with BMI≥25 kg/m2 were more likely to relapse(HR=20.196;95%CI,2.195-185.801;P=0.008),which was the risk factor of relapse.Conclusion:1.progestin therapy plus hysteroscopic lesion resection is an effective way for fertility sparing in treatment of early endometrial cancer and endometrial atypical hyperplasia.It is very important to choose the right time of hysteroscopic resection for diffuse lesions;2.BMI,polycystic ovary syndrome and lesion size are the influencing factors of complete remission.3.BMI,hormone type(maintenance therapy or not)and fertility medications therapy are the influencing factors of disease recurrence.4.BMI is an independent related factor affecting the complete remission and recurrence of preserving reproductive function treatment.BMI<25 kg/m2 is easier to achieve complete remission,BMI≥25 kg/m2 is more likely to relapse. |
