早期子宫内膜癌及子宫内膜非典型增生保守治疗回顾性研究

Fertility-sparing treatment of atypical endometrial hyperplasia and stage IA,well-differentiated endometrial carcinoma:A retrospective study

目的:回顾性分析早期子宫内膜癌及子宫内膜非典型增生患者应用高效孕激素为基础的保留生育功能治疗后的疗效、复发率及妊娠情况。方法:选取2010年1月至2022年12月就诊于郑州某医院和新乡某医院进行早期子宫内膜癌(endometrial carcinoma, EC)及子宫内膜非典型增生(atypical endometrial hyperplasia, AEH)保育治疗的患者为研究对象,分析EC组和AEH组完成治疗后的完全缓解率(complete response, CR)、部分缓解率(partial response, PR)、复发率(recurrence rate, RR)及妊娠结局。结果:共96例患者纳入分析,其中EC组33例,AEH组63例。治疗9个月评估时,EC组CR率为78.8%(26/33),AEH组CR率为82.5%(52/63),两组间差异无统计学意义(P>0.05),两组完全缓解率达83.3%。EC和AEH组获得病理起效的平均时间分别为(3.54±1.76)个月、(3.18±1.50)个月,获得完全缓解的平均时间分别为(5.71±2.40)个月、(5.39±2.65)个月。AEH组起效时间及完全缓解时间均短于EC组,但两组间无显著性差异(P>0.05)。EC组复发率为30.7%,平均复发时间为(21.11±11.00)个月;AEH组复发率为26.5%,平均复发时间为(33.23±14.96)个月。两组总体复发率为26.9%。平均复发时间为(28.61±14.59)个月,两组复发率比较无统计学意义(P>0.05)。两组共有58例(74.3%)患者要求治疗后立即妊娠,最终成功妊娠率为39.6%,总的妊娠次数25次,足月妊娠产下活产儿18个,活产率为78.2%。结论:EC和AEH采用高效孕激素为基础的保育治疗可以达到很高的缓解率及妊娠率,可以为不孕患者争取妊娠时间,但复发率高,妊娠完成后建议尽早手术治疗。

Objective:The present study investigated long term outcomes of conservative treatment of atypical endometrial hyperplasia(AEH)and endometrial carcinoma(EC),and post treatment conception.Methods:Atotal of 96 patients who received conservative treatment in the First Affiliated Hospital of Zhengzhou University and the First Affiliated Hospital of Xinxiang medical College from January 2010 to May 2022 were selected as the research objects,Complete response rate(CR),Partial response rate(PR),Recurrence rate(RR)and pregnancy outcomes of EC and AEH groups were analyzed.Results:A total of 96 patients were included in the analysis,including 33 patients in the EC group and 63 patients in the AEH group.At the evaluation of 9 months of treatment,the CR rate of the EC group was 78.8%(26/33)and the CR rate of the AEH group was 82.5%(52/63),with no statistical significance between the two groups(P>0.05)。and the complete response rate of the two groups reached 83.3%.The mean time to Partial response in EC and AEH groups was(3.54±1.76)months and(3.18±1.50)months,respectively,and the mean time to complete remission was(5.71±2.40)months and(5.39±2.65)months,respectively,there was no significant difference between the two groups(P>0.05).The recurrence rate of EC group was 30.7%,and the mean recurrence time was(21.11±11.00)months.The recurrence rate of AEH group was 26.5%,and the mean recurrence time was 33.23±14.96 months.The overall recurrence rate of the two groups was 26.9%.The mean recurrence time was(28.61±14.59)months.There was no statistical significance in recurrence rate between the two groups(P>0.05).A total of 58(74.3%)patients in the two groups wanted immediate pregnancy after treatment,and the final successful pregnancy rate was 39.6%,with a live birth rate of 78.2%,Conclusion:EC and AEH can achieve high remission rate and pregnancy rate by using highr effective progestogen based conservation therapy,which can save time for the patients with infertility,but the recurrence rate is high.Operation should be performed as soon as possible after pregnancy is completed.