高效孕激素治疗子宫内膜复杂不典型增生及子宫内膜癌的预后分析

Prognosis after fertility-sparing management with oral progestin for women with complex endometrial hyperplasia and endometrial cancer

目的探讨子宫内膜复杂不典型增生及高分化子宫内膜癌患者经高效孕激素治疗后的肿瘤学预后及生育结局。方法回顾性收集了2000年1月1日-2011年12月31日之间在北京协和医院就诊的子宫内膜复杂不典型增生及高分化子宫内膜癌(无子宫肌层浸润)患者的临床病理资料。所有患者接受口服醋酸甲羟孕酮(250~500 mg/d)或醋酸甲地孕酮(160~480 mg/d),持续至少6个月。结果患者中位年龄32岁(21~41岁)。在55例患者中,41例(75%)获得完全缓解,中位时间为6(3~24)个月。完全缓解率在肥胖患者中较非肥胖患者低(4/12[33%]比37/43[86%];P=0.001)。获得完全缓解的患者中10例(24%)复发。55例患者的5年无复发生存率为71%。在33例有生育愿望的患者中,17例(52%)妊娠。结论采用高效孕激素进行保留生育功能的治疗是有效和安全的。肥胖与预后不良相关。

Objective To investigate the oncologic and reproductive outcomes after progestin treatment of complex endometrial hyperplasia（ CEH） and grade 1 endometrial carcinoma（ EC）. Methods In a retrospective study,data were obtained for patients with CEH or grade 1 EC at presumed stage IA（ without myometrial invasion） who wished to preserve fertility and were treated at the Peking Union Medical College Hospital,China,between January 1,2000 and December 31,2011. Patients had received oral medroxyprogesterone acetate（ 250-500 mg/d） or megestrol acetate（ 160-480 mg/d） for at least 6 months. Results Among 55 included patients,median age was 32years（ range 21-41 years）. 41（ 75%） achieved complete response after a median period of 6（ 3-24） months.Complete response was less frequent among obese than nonobese patients（ 4/12 [33%] vs 37/43 [86% ]; P =0. 001）. Disease recurrence was recorded in 10（ 24%） patients with complete response; the 5-year recurrence-freesurvival rate was 71%. Among the 33 patients who retained a desire to conceive,17（ 52%） became pregnant.Conclusions Fertility-sparing management with oral progestin is effective and safe. Obesity is associated with a lower probability of long-term success.