Effect and Management of Excess Weight in the Context of Fertility-Sparing Treatments in Patients With Atypical Endometrial Hyperplasia and Endometrial Cancer: Eight-Year Experience of 227 Cases.

Ying Shan,Yan Li,Ling-Ya Pan,Yong-Xue Wang,Yan Cai,Wei Wang,Meng Qin,Ying Jin,Yu Gu,Jie Yin,Jia-Yu Chen

doi:10.3389/fonc.2021.749881

Abstract

ObjectiveTo investigate the oncologic and reproductive outcomes of fertility-sparing treatments (FSTs) in atypical endometrial hyperplasia (AEH) and endometrial cancer (EC) patients with excess weight (EW).MethodsThis retrospective study comprised patients with AEH or EC who achieved a complete response (CR) after FST from 2010 to 2018. The clinical characteristics, oncological and reproductive outcomes were compared between the excess weight (EW) group (body mass index (BMI)≥25 kg/m2) and normal weight (NW) group (BMI<25 kg/m2). The risk factors associated with recurrence and unsuccessful pregnancy in patients with EW were analyzed.ResultsOverall, 227 patients were enrolled, including 139 (61.2%) in EW group and 88 (38.8%) in NW group. In patients with EW, the pregnancy rate, the live birth rate and the relapse rate were 29.8%, 23.4%, and 30.9%, respectively. In patients with NW, these rates were 61.1%, 47.2%, and 31.8%, respectively. No significant differences were observed in the time to remission (P=0.865) and disease-free survival (DFS) (P=0.750). Patients in NW group achieved a better pregnancy rate than patients in the EW group (P=0.034). The patients with EW using ovulation induction to increase fertility tended to have a shorter time to pregnancy (P=0.042). However, no significant risk factors associated with unsuccessful pregnancy were identified after the multivariate analysis. In terms of DFS, the combination of gonadotropin-releasing hormone agonist (GnRH-a) and LNG-IUD was better for patients with EW than GnRH-a or oral progestin therapy alone (P=0.044, adjusted hazard ratio (HR)=0.432, 95% confidence interval (CI): 0.152-1.229), especially for patients with EW diagnosed with EC (P=0.032).ConclusionFSTs for overweight and obese patients should be more individualized. GnRH-a and/or LNG-IUD may be options prior to FSTs in patients with EW. Further prospective studies are needed.

Highlights

Endometrial cancer (EC) is one of the most common malignant tumors in females [1]
Patients who met the study inclusion criteria were divided into two groups: the excess weight (EW) group, body mass index (BMI) of which was equal to or more than 25 kg/m2; the normal weight (NW) group, BMI of which was less than 25 kg/m2
A total of 63.0% of patients were diagnosed with Atypical endometrial hyperplasia (AEH), and 37.0% were diagnosed with EC

Summary

Introduction

Endometrial cancer (EC) is one of the most common malignant tumors in females [1]. EC usually arises in postmenopausal women, but approximately 10% of EC patients are younger than 40 years old [2]. The risk of AEH progressing to EC within fifteen years has been reported to be as high as 29.0% [3, 4]. Therapy for both AEH and EC should warrant attention. The incidence of young patients with AEH and EC has increased worldwide, and fertility-sparing treatments (FSTs) to preserve reproductive function are urgently needed [5]. 80% of young EC patients have welldifferentiated type I disease at a very early stage and highestrogen exposure backgrounds, presenting the possibility of progestin-based therapy [6]. The risk factors for recurrence must be identified to decrease the risk of recurrence

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Discussion

Conclusion