Objective: To investigate the efficacy and pregnancy outcome of fertility-preserving treatment for patients with stage Ⅰa, grade 2 endometrial cancer (EC). Methods: Clinical data was retrospectively collected for EC or atypical endometrial hyperplasia (AEH) patients treated in Peking University People's Hospital, Foshan First People's Hospital of Guangdong Province and First Affiliated Hospital of Sun Yat-sen University, from 2010 to 2019. Inclusion criteria for fertility-preserving treatment included: (1) Age ≤45 years. (2) EC with histological differentiation of G(1), G(2) or endometrial AEH. (3) EC disease should be stage Ⅰa, confined to the endometrium without myometrial invasion, lymph node or extrauterine metastasis. Treatment regimen: patients were given oral progestin therapy and endometrial pathology was evaluated every three months. Patients were divided into three groups as G(2) EC group, G(1) EC group and AEH group based on the histological differentiation. Oncological and pregnancy outcomes were compared among them. Results: (1) Totally 57 eligible patients were included in this study, including 11 cases with G(2) EC, 22 cases with G(1) EC, and 24 cases with AEH. (2) Oncological outcome: among the three groups of G(2) EC, G(1) EC and AH, the complete remission rates (9/11, 91% and 96%, respectively) and recurrence rates (3/9, 30% and 22%, respectively) were not significantly different (all P>0.05). Median remission time was significantly longer in the G(2) EC group than those in the other two groups (8, 6 and 4 months; P=0.046). Among 9 G(2) EC patients who recurred after complete remission, three patients relapsed at 7, 18 and 53 months, respectively. All 3 patients chose fertility-sparing treatment again, and all achieved complete remission after retreatment. (3) Pregnancy outcome: among the three groups, the assisted reproduction technology rates (4/8, 5/18 and 36%, respectively) and pregnancy rates (6/8, 5/18 and 36%, respectively) had no significant difference (P>0.05). However, time interval to pregnancy was shorter in G(2) EC patientsthan the other two groups (4, 9 and 22 months, respectively; P=0.006). Conclusions: Fertility-preserving treatment for patients with stageⅠa, G(2) endometrial cancer, may obtain a relatively high remission rate and an acceptable pregnancy rate. However, further exploration is needed due to the limited number of cases.
目的： 初步探讨中分化Ⅰa期子宫内膜癌患者保留生育功能治疗的肿瘤结局和妊娠结局。 方法： 收集2010—2019年北京大学人民医院、广东省佛山市第一人民医院、中山大学附属第一医院共3家医院收治的保留生育功能治疗的Ⅰa期子宫内膜癌及子宫内膜非典型增生患者的临床资料。给予保留生育功能治疗的纳入标准：（1）年龄≤45岁；（2）病理类型为高分化、中分化子宫内膜癌或子宫内膜非典型增生；（3）若为子宫内膜癌，需证实为Ⅰa期、病变局限于子宫内膜，并经影像学检查评估无任何可疑的子宫肌层浸润、淋巴结转移、子宫外转移。保留生育功能治疗方法：给予口服大剂量孕激素治疗，每3个月复查子宫内膜病理并评估疗效。根据保留生育功能治疗前的病理检查结果将纳入患者分为中分化子宫内膜癌组、高分化子宫内膜癌组和子宫内膜非典型增生组，比较3组患者的肿瘤结局及妊娠结局。 结果： （1）本研究共纳入57例符合条件的患者，包括中分化子宫内膜癌组11例，高分化子宫内膜癌组22例，子宫内膜非典型增生组24例。（2）肿瘤结局：中分化子宫内膜癌组、高分化子宫内膜癌组、子宫内膜非典型增生组患者的完全缓解率（分别9/11、91%和96%）、复发率（3/9、30%、22%）分别比较，差异均无统计学意义（P>0.05）；中分化子宫内膜癌组患者达到完全缓解所需时间长于高分化子宫内膜癌组、子宫内膜非典型增生组（中位时间分别为8、6、4个月），3组比较，差异有统计学意义（P=0.046）。9例初次治疗完全缓解的中分化子宫内膜癌患者中，3例分别于完全缓解后7、18、53个月复发，均选择再次保留生育功能治疗，并均再次获得完全缓解。（3）妊娠结局：中分化子宫内膜癌组、高分化子宫内膜癌组、子宫内膜非典型增生组患者的辅助生殖治疗率（分别为4/8、5/18、36%）、妊娠率（分别为6/8、5/18、36%）分别比较，差异均无统计学意义（P>0.05）；但中分化子宫内膜癌组患者获得妊娠所需时间显著短于另外两组（中位时间分别为4、9、22个月，P=0.006）。 结论： 中分化Ⅰa期子宫内膜癌患者经过保留生育功能治疗，能够获得较高的完全缓解率和一定的妊娠率，但因本研究病例数有限，尚需进一步探索研究。.
Keywords: Endometrial hyperplasia; Endometrial neoplasms; Fertility preservation; Pregnancy outcome.