子宫内膜不典型增生和子宫内膜癌患者保留生育功能治疗过程中不良反应分析

Analysis of adverse reactions of fertility-sparing treatment for patients with endometrial carcinoma and endometrial atypical hyperplasia

目的 分析子宫内膜不典型增生(EAH)和子宫内膜癌(EC)患者保留生育功能(保育)治疗期间的不良反应,探讨其与治疗方案和疗效的关系。方法 收集2018年7月至2021年6月于北京大学人民医院进行保育治疗的EAH和EC患者的临床资料,采用问卷方式分析患者在治疗中出现的不良反应。结果 共纳入符合条件的35例EAH和35例EC患者。主要不良反应有阴道流血(74.3%)、体重增加(40.0%)、潮热多汗(37.1%)、情绪改变(31.4%)等。大部分患者可以耐受或治疗后好转。不同治疗方案的不良反应发生率差异无统计学意义。无阴道流血组患者的3个月缓解率高于阴道无诱因流血组(50.0%vs. 16.7%,P=0.014),无诱因阴道流血和病理类型为EC是3个月无缓解的独立危险因素。体重增加组、减少组和不变组的3个月及6个月缓解率、中位完全缓解时间差异均无统计学意义(P>0.05)。结论 EC和EAH患者保育治疗中,不良反应发生率较高,与治疗方案无关,患者总体可以耐受。阴道流血与较低的早期缓解率相关,可作为孕激素治疗敏感度的参考指标。体重变化对疗效可能无影响。

Objective To study the adverse reactions of fertility-sparing treatment for patients with endometrial atypical hyperplasia(EAH)and endometrial cancer(EC),and analyze their relationship with treatment protocol and clinical effects.Methods The clinical data and side effects of patients with EAH and EC treated in Peking University People ’s Hospital from July 2018 to June 2021 who required fertility-sparing treatment were collected and analyzed by questionnaires.Results Totally 35 patients with EAH and 35 patients with EC were included. Adverse reactions mainly included vaginal bleeding(74.3%),weight gain(40.0%),hot flashes(37.1%)and mood change(31.4%). Most patients could tolerate or get better after treatment. There was no statistical difference in the incidence of adverse reactions among different treatment regimens.Complete response rate(CRR)after three months of patients without bleeding was higher than that of patients who bled without inducements(50.0% vs. 16.7%,P=0.014).Vaginal bleeding without inducements and EC were independent risk factors for CR failure at 3 months. There was no difference in median response duration(MRD)and CRR of three months and six months among weight gain group, weight loss group and weight invariant group(P>0.05).Conclusions Adverse effects during treatment are normal which have no statistical association with therapy,but most of them are tolerable after symptomatic treatments or tolerance established.Vaginal bleeding which is the most common side effect often indicates lower early response rate,reflecting the patient’s sensitivity to therapy.Weight gain during treatment are not associated with clinical outcome.