早期高分化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结局分析

Survival Outcomes of Fertility-Preserving Therapy in Patients with Early Well-Differentiated Endometrial Carcinoma and Atypical Endometrial Hyperplasia

目的:探讨早期高分化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结局。方法:回顾性分析2010年1月至2017年12月就诊于北京大学第三医院要求保留生育功能的早期高分化子宫内膜癌患者43例及不典型增生患者77例的临床病理资料及治疗结局。结果:保守治疗的完全缓解(CR)率为96.67%(116/120),不典型增生组患者保守治疗3个月CR的比例显著高于子宫内膜癌组(74.03%vs 41.86%,P<0.05)。109例患者有妊娠要求,妊娠率为43.12%(47/109)、活产率为33.03%(36/109)。分析显示,体质量指数(BMI)、是否癌变及合并有糖尿病或胰岛素抵抗与治疗缓解后能否成功妊娠有关(P<0.05),而治疗获得CR的时间及缓解后维持治疗与妊娠无关(P>0.05)。复发率为32.76%(38/116),中位复发间隔为17月,是否癌变(RR 5.624)是影响复发的独立危险因素(P<0.05),达CR后的维持治疗(RR 0.385)及妊娠(RR 0.382)是影响复发的保护性因素(P<0.05)。子宫内膜癌组的中位复发间隔为13月,子宫内膜不典型增生组为24月,两组差异有统计学意义(P<0.05)。复发后重复孕激素治疗的有效率为100.00%(31/31)。结论:早期高分化子宫内膜癌和不典型增生的有生育要求的患者,保守治疗安全有效。保守治疗3个月子宫内膜不典型增生疗效好于子宫内膜癌。BMI、是否合并糖尿病和胰岛素抵抗及癌变与其妊娠有关,治疗达CR后的维持治疗并不影响妊娠,但治疗后复发率较高,妊娠和维持治疗是预防复发的保护因素。复发后重复保守治疗仍然有效。

Objective:To investigate the survival outcomes and factors influencing fertility-preserving therapy in patients with early well-differentiated endometrial carcinoma(EC)and atypical endometrial hyperplasia(AEH).Methods:Clinicopathological data and survival outcomes of 43 patients with early well-differentiated EC and 77 patients with AEH were retrospectively analyzed.All included patients were admitted to Peking University Third Hospital from January 2010 to December 2017 and had strong fertility-preserving desire.Results:The complete response rate of conservative treatment was 96.67%(116/120).More patients with AEH achieved complete response at 3 months compared with those with EC(74.03%vs.41.86%,P<0.05).Among 109 patients with pregnancy requirements,the pregnancy rate was 43.12%(47/109),and the delivery rate was 33.03%(36/109).Body mass index,diabetes mellitus or insulin resistance and endometrial cancer were associated with pregnancy outcomes(P<0.05),while maintenance treatment after complete response did not affect pregnancy outcomes(P>0.05).The recurrence rate was 32.76%(38/116),and the median recurrence interval was 17 months,canceration(RR 5.624)was independently associated with recurrence(P<0.05),while maintenance therapy(RR 0.385)and pregnancy after CR(RR 0.382)presented as protective factors against recurrence(P<0.05).Median recurrence interval of the endometrial cancer group was significantly lower than the endometrial atypical hyperplasia group(13 months vs.24 months,P<0.05).The response rate of recurrent progesterone therapy was 100.0%(31/31).Conclusions:Conservative treatment is safe and effective for patients with early well-differentiated EC and AEH with fertility requirements.In AEH group,more patients reached complete response at 3 months.BMI,diabetes mellitus or insulin resistance and canceration are associated with pregnancy,while maintenance therapy after complete response does not affect pregnancy.The recurrence rate of conservative therapy is high,with pregnancy and maintenance therapy as protective factors to prevent recurrence.Conservative treatment after relapse is still effective.