Clinical outcomes analysis of fertility-preserving therapy for atypical endometrial hyperplasia and early endometrial carcinoma / 中华肿瘤杂志

Objective: To analyze the clinical efficacy of fertility-preserving therapy in patients with atypical endometrial hyperplasia (AEH) and early endometrial carcinoma (EC). Methods: The general condition, pathological type, treatment plan, tumor outcomes and pregnancy outcomes of 110 patients with AEH and EC treated with fertility-preserving therapy in Peking University People's Hospital from December 2005 to September 2019 were retrospectively analyzed. Kaplan-Meier and Log rank tests were used for survival analysis. Results: The response rate of 110 cases of AEH (62 cases) and EC (48 cases) was 94.5% (104/110) after fertility-preserving therapy. There were 93 cases (84.5%) achieved complete response and 11 cases (10.0%) achieved partial response, and the recurrence rate was 29.0% (27/93). The complete response rates of AEH and EC were 90.3% (56/62) and 77.1% (37/48), respectively, without significant difference (P=0.057). The recurrence rates of EC were significantly higher than that of AEH (40.5% vs 21.4%; P=0.022). Forty-one patients with complete response had pregnancy intention, the pregnancy rate was 70.7% (29/41), and the live birth rate was 56.1% (23/41). The live birth rate of AEH was 68.2% (15/22) and that of EC was 42.1% (8/19), the difference was statistically significant (P=0.032). The pathological type was related with the recurrence (P=0.044). Conclusions: Patients with AEH and EC can obtain high complete response rate and pregnancy rate after fertility-preserving therapy. The recurrence rate of EC is higher than that of AEH, while the live birth rate of AEH is higher than that of EC.

Long-term outcomes of progestin plus metformin as a fertility-sparing treatment for atypical endometrial hyperplasia and endometrial cancer patients / 부인종양

OBJECTIVE: The present study investigated long-term outcomes of medroxyprogesterone acetate (MPA) plus metformin therapy in terms of control of atypical endometrial hyperplasia (AEH) and endometrial cancer (EC), and post-treatment conception. METHODS: We retrospectively analyzed 63 patients (42 with EC; 21 with AEH) who underwent fertility-sparing management using MPA plus metformin. MPA (400 mg/day) and metformin (750–2,250 mg/day) were administered to achieve complete response (CR). Metformin was administered until conception, even after MPA discontinuation. RESULTS: Of the total patients, 48 (76%) had a body mass index (BMI) ≥25 kg/m² and 43 (68%) showed insulin resistance. Sixty-one patients (97%) achieved CR within 18 months. CR rates at 6, 8–9, and 12 months were 60%, 84%, and 90%, respectively. During a median follow-up period of 57 months (range, 13–115 months), relapse occurred in 8 of 61 patients (13.1%) who had achieved CR. Relapse-free survival (RFS) in all patients at 5 years was 84.8%. Upon univariate analysis, patients with BMI ≥25 kg/m² had significantly better prognoses than did those with BMI <25 kg/m2 (odds ratio=0.19; 95% confidence interval=0.05–0.66; p=0.009). Overall pregnancy and live birth rates per patient were 61% (19/31) and 45% (14/31), respectively. CONCLUSIONS: MPA plus metformin is efficacious in terms of RFS and post treatment conception. Moreover, metformin may be more efficacious for patients with BMI ≥25 kg/m².

The factors analysis on pregnant outcomes between well-differentiated endometrial cancer and atypical endometrial hyperplasia after conservative treat ment / 实用肿瘤学杂志

Objective To identify factors that might affect establishing pregnancy following conservative treatment by medroxyprogesterone acetate ( MPA)for well -differentiated endometrioid adenocarcinoma ( EC) or a-typical endometrial hyperplasia(AEH).Methods A retrospective study of 65 patients with EC/AEH were divid-ed into a pregnancy group ( n=34 ) and a non -pregnancy group ( n=31 ) .The influent factors on establishing pregnancy were detected by statistical analysis .Results There was no significant difference in clinical character-istics between pregnancy group and non -pregnancy group .There were significantly different between pregnancy group and non-pregnancy in the duration of MPA administration ,the time to disappearance of lesions ,the age of pregnancy permission ,the number of D&C procedures performed ,and endometrial thickness during ovulation ( P<0.05).The multivariate logistic regression analysis identified that the recurrence (OR=2.323,P=0.015),endo-metrial thickness during ovulation (OR=0.283,P <0.001),and age of pregnancy permission (OR=2.524,P=0.039) were significant factors affecting pregnancy outcomes .Conclusion Recurrence, endometrial thickness during ovulation ,and the age of the pregnancy permission were considered to affect pregnant establishment follow -ing conservative treatment with MPA .Assisted reproductive technology immediately after achieving tumor disap-pearance by MPA would therefore be beneficial for patients with disease recurrence ,thin endometrium ,or a higher age of pregnancy permission .

Efficacy observation of medroxyprogesterone acetate in treatment of atypical endometrial hyperplasia / 中国生化药物杂志

Objective To investigate the clinical efficacy and safety of medroxyprogesterone acetate in the treatment of endometrial atypical hyperplasia patients.Methods 98 cases of endometrial atypical hyperplasia patients were randomly divided into study group and control group with 49 cases in each group, study group were treated with medroxyprogesterone acetate treatment, and control group were given estradiol valerate tablets treatment.Two groups of patients were treated for 3 ~6 menstrual cycles, and clinical curative effect of two groups was compared.Results After treatment, the PBAC score and endometrial thickness inspection results in study group and control group respectively decreased significantly compared with before treatment (P<0.05), and the above indexes in study group were significantly lower than control group (P<0.05).After treatment, the hemoglobin value in two groups at 1st, 2nd, 3rd month after treatment was significantly higher than before treatment (P<0.05), and hemoglobin values at 1st, 2nd month after treatment was significantly higher than control group (P<0.05).The effective rate of study group (95.92%) was significantly higher than that of control group (81.63%, P<0.05).The recurrence rate during six months was 4.08% in study group, 8.16% in control group, and the difference was not statistically significant.Conclusion The efficacy of medroxyprogesterone acetate is better than estradiol valerate tablets in the treatment of endometrial atypical hyperplasia patients, which is safe and effective.