Abstract
BackgroundFertility-sparing therapy is an alternative conservative treatment for patients with early stage endometrioid cancer or atypical endometrial hyperplasia. In this study, we investigated pregnancy outcomes and pregnancy-associated factors in young patients receiving hormonal therapy.MethodsWe retrospectively analyzed 68 patients who attempted to conceive after fertility-sparing therapy and achieving complete remission (CR). They were divided into a pregnancy group and a non-pregnancy group. A Cox proportional hazard regression model was applied for univariate and multivariate analysis to determine factors associated with pregnancy. Kaplan–Meier analysis, combined with the log-rank test, was used to calculate a patient’s pregnancy probability and the distribution of recurrence-free survival (RFS).ResultsA total of 36 patients became pregnant with 47 pregnancies. Univariate and multivariate Cox analysis revealed that several factors were associated with pregnancy, including BMI at the time of pregnancy permission, the time to CR, prolonged treatment time, the number of hysteroscopy procedures, the endometrium thickness after CR, and relapse before pregnancy. The mean RFS of patients who achieved pregnancy, and those who did not, was 27.6 months and 14.8 months, respectively (P = 0.002). No significant difference was detected in terms of cumulative RFS when compared between assisted reproductive technology (ART) cases and those involving natural conception (NC) (P = 0.707).ConclusionsNormal BMI, a shorter time to CR, a prolonged three-month treatment, fewer hysteroscopy procedures, and a thicker endometrium may be positive indicators for successful pregnancies, while relapse before pregnancy may have a negative effect on conception. Moreover, a successful pregnancy protects the endometrium while ART does not increase the risk of recurrence.
Highlights
Fertility-sparing therapy is an alternative conservative treatment for patients with early stage endometrioid cancer or atypical endometrial hyperplasia
This study aimed to investigate pregnancy outcomes and analyze factors associated with pregnancy in young endometrioid adenocarcinoma (EEC) and Atypical endometrial hyperplasia (AEH) patients who received fertilitysparing management
Patients were selected for fertility-sparing treatment if they fulfilled the following conditions: (1) age ≤ 45 years with a strong desire for fertility; (2) diagnosed with AEH or endometrioid adenocarcinoma; (3) lesions confined to the endometrium, as determined by imaging (MRI); (4) positive expression of estrogen receptor and progesterone receptor expression; and (5) the patient signed an informed consent form and underwent an appropriate period of follow-up
Summary
Fertility-sparing therapy is an alternative conservative treatment for patients with early stage endometrioid cancer or atypical endometrial hyperplasia. Atypical endometrial hyperplasia (AEH) is a precancerous lesion and 29% of such cases progress to EC within a few years [2]. Research studies have increasingly recognized the safety and efficacy of a conservative form of treatment involving high-dose progestin for patients with AEH and early stage endometrioid adenocarcinoma (EEC) [4,5,6,7,8,9,10]. Fertility-sparing therapy aims to temporarily reverse endometrial lesions via the use of a large amount of progesterone, creating a safe time window for pregnancy and fertility. Relevant studies have already reported the pregnancy outcomes of patients with EEC and AEH patients following such therapeutic intervention [11,12,13,14,15,16,17]
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