早期子宫内膜癌保留生育功能治疗的临床分析

Clinical analysis of fertility-preserving treatment in patients with endometrial carcinoma

目的评估早期子宫内膜癌行保留生育功能治疗的可行性、有效性和结局。方法回顾性分析北京协和医院自1998年6月～2004年12月接受保留生育功能治疗的12例早期子宫内膜癌患者的临床资料。结果患者年龄21～35岁,平均29岁。其中33.3%合并不孕,41.7%合并多囊卵巢综合征。高分化11例,高-中分化1例;FIGOⅠ_a期10例,Ⅰ_b期2例;孕激素受体阳性10例,阴性2例。安宫黄体酮500mg/d或己酸孕酮250mg/d治疗3～10个月,完全缓解9例(75%),无缓解3例(25%);完全缓解的9例中复发2例(22.2%);最后行子宫切除术5例。随诊36～108个月,12例均无瘤存活,无1例妊娠。结论保留生育功能治疗对于仔细选择的年轻子宫内膜癌妇女是可行的。由于病理完全缓解的患者在长期观察中的复发率仍高,故应强调密切随访。

Objective To assess the feasibility, efficiency and outcome of fertility-preserving treatment of FIGO stage I endometrial adenocareinoma. Methods Twelve cases of FIGO stage I endometrial adenocarcinoma, who were treated with medical management in Peking Union Medical College Hospital between June 1998 and December 2004, were retrospectively reviewed. Results The median age was 29 years （range, 21 -35 years）. Among these cases 33.3% had infertility and 41.7% had polycystic ovary syndrome. Eleven of 12 cases had G1 tumors, and the remaining one had G1 - G2 tumor. Ten of 12 cases were at FIGO Ia stage, and the remaining two at FIGO Ib stage. Ten of 12 cases were progesterone receptor-positive, and two were progesterone receptor-negative. Twelve cases with FIGO stage I endometrial adenocarcinoma were initially treated with MPA 500mg/day or hydroxyprogesterone Caproate Injection 250mg/day for 3 - 10 months. Nine of 12 cases （75%） had complete treatment response and three （25%） had no response. Two of 9 complete initial responders （22. 2% ） had relapses. Three cases with no response and two with relapse underwent hysterectomies. The length of follow-up was 36 - 108 months, 12 cases had disease-free survival. None of 12 cases had pregnancy. Conclusion Fertility- preserving treatment is feasible in carefully selected young women with FIGO stage I endometrial carcinoma. Recurrence rate remains high in long-term follow-up after pathological complete remissions.