早期子宫内膜癌及子宫内膜不典型增生患者保留生育功能治疗的疗效及安全性分析

Efficacy and security of fertility-sparing treatment for early-stage endometrial cancer and atypical endometrial hyperplasia

目的探讨早期子宫内膜癌(EC)及内膜不典型增生(AEH)保留生育功能治疗的疗效及安全性。方法回顾性分析2010年1月至2018年12月首都医科大学附属北京天坛医院收治的早期EC(20例)及AEH(25例)患者的临床资料,采用醋酸甲羟孕酮(MPA)或甲地孕酮(MA)口服,联合或单独使用左炔诺孕酮宫内缓释系统(LNG-IUD),随访6~60个月,分析治疗结局及治疗失败的原因。结果 EC组和AEH组的BMI、既往史、临床表现比较,差异均无统计学意义(P> 0.05)。45例患者中,37例(82.2%)完全缓解,其中AEH组为92%,EC组为70%;3例(6.7%)部分缓解,均为EC患者在随访期间内经孕激素治疗后逆转为AEH;3例(6.7%)对治疗无反应,其中2例AEH患者经孕激素治疗3~6个月后仍为AEH,1例EC患者经孕激素治疗4个月后仍为EC;2例(4.4%)病情进展,其中1例EC患者为子宫内膜样腺癌G3ⅣB期,1例EC患者进展为子宫内膜样腺癌G1Ⅱ期。AEH组妊娠率为36.4%(6/11),EC组为22.2%(3/9)。1例肥胖患者(BMI42.68 kg/m^2)在服用MPA第4个月时发生了左侧横窦和乙状窦静脉血栓。结论早期EC及AEH保留生育功能的治疗是有效的,但仍存在病情进展及严重药物不良反应的风险。

Objective To evaluate the efficacy and security of fertility-sparing treatment for early-stage endometrial cancer(EC)and atypical endometrial hyperplasia(AEH)in young women.Methods The clinical data of early EC(20 cases)and AEH(25 cases)patients admitted to Beijing Tiantan Hospital affiliated to Capital Medical University from January 2010 to December 2018 were retrospectively analyzed.Oral administration of medroxyprogesterone acetate(MPA)or medroprogesterone acetate(MA),combined with or alone with levonorgestrel intrauterine sustained-release system(LNGIUD).The patients were followed up for 6~60 months to analyze the treatment outcome and the reasons for treatment failure.Results There was no significant difference in BMI,previous history and clinical manifestations between the EC group and the AEH group(P>0.05).Of the 45 patients,37(82.2%)had complete remission,including 92%in the AEH group and 70%in the EC group.Three patients(6.7%)experienced partial remission,all of which were EC patients who were reversed to AEH after progesterone therapy during the follow-up period.Three patients(6.7%)did not respond to treatment,among which two AEH patients remained AEH after 3~6 months of progesterone therapy.One EC patient remained after 4 months of progesterone therapy.In 2 cases(4.4%)of disease progression,among them,one patient with endometrial adenocarcinoma G3ⅣB,the other case with endometrial adenocarcinoma G1Ⅱperiod.The pregnancy rate was 36.4%(6/11)in the AEH group and 22.2%(3/9)in the EC group.Thrombosis of left transverse sinus and sigmoid sinus vein occurred in one obese patient(BMI 42.68 kg/m^2)at 4 months after taking MPA.Conclusion The fertility-sparing treatment for early-stage EC and AEH is effective,but there is still a risk of disease progression and serious adverse effects.