宫腔镜检查联合药物治疗早期子宫内膜癌的预后和妊娠结局影响因素分析

Analysis of factors affecting prognosis and pregnancy outcome of early endometrial carcinoma treated by hysteroscopy combined with drug therapy

目的探讨经宫腔镜手术联合药物治疗早期子宫内膜癌达完全缓解所需时间与临床特征的相关性,以及影响患者预后、妊娠结局的因素。方法回顾性分析2010年1月至2022年10月于北京大学第三医院行宫腔镜手术+药物保守治疗的89例ⅠA期中-高分化子宫内膜癌患者的临床资料,分析保守治疗3个月后疗效的影响因素,并比较3个月后完全缓解(CR)和其他临床因素与妊娠成功、复发的相关性。结果89例患者中,随访资料完整84例,中位随访时间为23个月。3个月达CR者64例(80.0%),6个月达CR者83例(93.3%)。3个月CR与年龄呈正相关(P<0.05),与血脂异常呈负相关(P<0.05)。其中66例患者有妊娠需求,妊娠率为42.4%(28/66),活产率为27.3%(18/66)。妊娠与年龄呈负相关,与辅助生殖助孕呈正相关(P<0.05)。3个月CR与妊娠无相关性(P>0.05)。复发19例(22.6%,19/84),复发间隔时间为3~61个月,中位复发间隔时间为7个月,复发后继续保守治疗至6个月的患者均CR。Kaplan-Meier分析提示,子宫内膜厚度≥10 mm者更易复发(P<0.05),多因素COX回归分析提示,复发与子宫内膜厚度、3个月CR等临床因素无相关性(P>0.05)。结论子宫内膜样癌患者保守治疗成功率高,年龄较大者3个月易达CR,血脂异常是影响3个月CR的不利因素。年龄增加是影响治疗后妊娠成功的不利因素,辅助生殖技术可提高妊娠成功率。子宫内膜厚度可能影响疾病复发。治疗3个月后CR不影响妊娠或疾病复发。复发后保守治疗依然有效。

Objective To investigate the correlation between the time required to achieve complete remission(CR)of early endometrial cancer by hysteroscopic surgery combined with drug therapy and clinical characteristics,and to analyze the factors affecting the prognosis and pregnancy outcome of patients.Methods A retrospective analysis was performed on 89 patients with early endometrial cancer who underwent hysteroscopic surgery and drug therapy in the Third Hospital of Peking University from January 2010 to October 2022.The factors affecting the efficacy of conservative treatment after 3 months were analyzed and compared,and the correlation between CR after 3 months and other clinical factors and pregnancy success and recurrence was compared.Results 84 cases were followed up completely,with a median follow-up time of 23 months.64 cases(80.0%)reached CR after 3 months,83 cases(93.3%)reached CR after 6 months.Three-month CR was positively correlated with age and negatively correlated with dyslipidemia(P<0.05).Sixty-six patients had pregnancy needs.The pregnancy rate was 42.4%(28/66)and the live rate was 27.3%(18/66).Pregnancy was negatively correlated with age,and positively correlated with assisted reproduction(P<0.05).There was no correlation between 3-month CR and pregnancy(P>0.05).There were 19 cases(22.6%)with recurrence interval of(3~61)months and median recurrence interval of 7 months.All patients who continued conservative treatment until 6 months after recurrence were CR.Kaplan-Meier analysis showed that patients with endometrial thickness≥10 mm were more likely to relapse(P<0.05).Multivariate COX regression analysis showed that there was no correlation between recurrence and clinical factors such as endometrial thickness and 3-month CR(P>0.05).Conclusions Patients with endometrioid carcinoma have a high success rate of conservative treatment.The older patients can easily reach CR after 3 months.Abnormal blood lipid is an adverse factor affecting the 3-month CR.Age is an adverse factor affecting the success of pregnancy after treatment,and assisted reproductive technology can improve the success rate of pregnancy.The thickness of endometrium may affect the recurrence of the disease.After 3 months of treatment,CR did not affect pregnancy or disease recurrence.Conservative treatment is still effective after recurrence.