医学
醋酸甲孕酮
保持生育能力
孕激素
泌尿科
子宫内膜癌
妇科
阶段(地层学)
内科学
肿瘤科
比例危险模型
癌症
生育率
激素
人口
古生物学
环境卫生
生物
作者
A Jin Lee,Eun Jung Yang,Nam Kyeong Kim,Yeorae Kim,Dong Hoon Suh,Jeeyeon Kim,Joo-Hyuk Son,Tae-Wook Kong,Suk-Joon Chang,Dong Won Hwang,Soo‐Jin Park,Hee Seung Kim,Ji Geun Yoo,Sung Jong Lee,Yoo-Young Lee,Seung‐Hyuk Shim
标识
DOI:10.1016/j.ygyno.2023.04.027
摘要
To evaluate oncologic and pregnancy outcomes of fertility-sparing treatment (FST) using progestin in patients with stage I grade 2 endometrioid endometrial cancer (EC) without myometrial invasion (MI) or grade 1-2 with superficial MI.Multicenter data of patients with stage I grade 2 EC without MI or grade 1-2 EC with superficial MI, who received FST between 2005 and 2021, were analyzed. Cox regression analysis identified independent factors for progressive disease (PD) during the FST.Altogether, 54 patients received FST [medroxyprogesterone acetate (500-1000 mg) in 44, megestrol acetate (40-800 mg) in 10] with concurrent levonorgestrel-releasing intrauterine devices use in 31. With median time to achieve a complete response (CR) of 10 (3-24) months, 39 patients (72.2%) achieved CR. Of the 15 patients who attempted to conceive after achieving CR, 7 (46.7%) became pregnant (2 abortions, 5 live births). During a median FST duration of 6 (3-12) months, nine patients (16.6%) were diagnosed with PD. Fifteen (38.5%) experienced recurrence with a median recurrence-free survival of 23 (3-101) months. In the multivariable analysis, tumor size before FST ≥2 cm (HR 5.456, 95% CI 1.34 to 22.14; p = 0.018) was significantly associated with a high PD rate during FST.The overall response rate to FST was promising, however, the PD rate was significant during the first 12 months of FST. Therefore, performing thorough endometrial biopsy and imaging studies is essential to strictly evaluate the extent of the disease every 3 months from FST initiation.
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