子宫内膜不典型增生/早期子宫内膜癌患者保留生育功能治疗后IVF-ET妊娠结局及复发因素分析

The analysis of reproductive outcomes and recurrence of patients undergoing in vitro fertilization-embryo transfer after fertility-sparing treatment for atypical endometrial hyperplasia and endomtrial cancer

目的分析子宫内膜不典型增生/早期子宫内膜癌(AH/EEC)患者保留生育功能治疗后接受体外受精-胚胎移植(IVF-ET)治疗的临床特点和预后,分析影响助孕妊娠结局和疾病复发的主要因素。方法回顾性分析2012年2月至2022年2月在北京协和医院接受AH/EEC生育保留治疗后进行IVF-ET治疗的78例患者的临床资料。总结分析纳入患者的临床特征、IVF-ET相关指标、妊娠结局和复发情况,以单因素和多因素分析临床妊娠率、活产率以及疾病复发的影响因素。结果78例患者中51例(65.38%)为AH患者,27例(34.62%)为EEC患者;开始IVF-ET周期的平均年龄为(34.17±3.70)岁。共有74例患者至少接受了1次移植,每移植周期的临床妊娠率和活产率分别为36.31%(65/179)和18.99%(34/179),累积妊娠率为72.97%(54/74)。多因素分析提示子宫内膜病变初次发病年龄是活产率的独立影响因素[OR=0.8794,95%CI(0.785,0.983),P=0.02]。纳入患者IVF-ET期间子宫内膜病变的总复发率为6.41%(5/78),多因素分析提示子宫内膜病变的病理类型和IVF-ET前复发史是疾病复发的危险因素(P<0.05)。结论AH/EEC患者保留生育功能治疗后的辅助生殖结局相对满意,在肿瘤治疗过程中,进行病变评估时应尽量保护内膜,减少损伤;在肿瘤治疗结束后,应尽快进行助孕治疗,以最大程度降低复发率。

Objective:To summarize the clinical characteristics and prognosis of patients undergoing in vitro fertilization-embryo transfer(IVF-ET)after fertility-sparing treatment for atypical endometrial hyperplasia and early endometrial cancer(AH/EEC),and to analyze the main factors for reproductive outcomes and disease recurrence.Methods:A retrospective analysis was performed for the clinical data of patients who received assisted reproductive technology(ART)treatment after AH/EEC fertility-sparing treatment in Peking Union Medical College Hospital from February 2012 to February 2022.Clinical features,indicators related to IVF-ET,reproductive outcomes and recurrence were summarized.Risk factors for clinical pregnancy and live birth rates as well as recurrence rates were evaluated with univariate and multivariate analyses.Results:A total of 78 patients recruited in the study.There are 51(65.38%)AH patients and 27(34.62%)EEC ones.The average age at the initiation of an IVF-ET cycle was 34.17±3.70 years.A total of 74 patients received at least one time of embryo transfer.The clinical pregnancy rate and live birth rate per ET were 36.31%(65/179)and 18.99%(34/179),respectively,and the cumulative pregnancy rate was 72.97%(54/74).Multivariate analysis suggests that the initial onset age of AH/EEC was the independent risk factor for live birth rate[OR=0.8794,95%CI(0.785,0.983),P=0.02].The overall recurrence rate of AH/EEC in IVF-ET cycle was 6.41%(5/78).Both the pathological type of endometrial lesions and the history of recurrence before IVF-ET were significantly correlated with the recurrence of disease(P<0.05).Conclusions:The reproduction outcomes after fertility-sparing treatment are relatively satisfied.Attention should be paid to protecting the endometrium and reducing damage during evaluation of the endometrial lesion.Fertility treatment should be given as soon as possible after the oncology treatment to minimize the recurrence rate.