Abstract
ObjectiveTo evaluate the effect of maintenance therapy for patients with atypical endometrial hyperplasia (AEH) and early endometrial cancer (EC) after successful fertility-preserving management on prognosis and pregnancy outcome.MethodsWe performed a retrospectively analysis of 109 young women with atypical endometrial hyperplasia and early endometrioid endometrial cancer who had received complete response after fertility-preserving treatment at 5centers between May 2005 and March 2021. Maintenance therapy regimes included low-dose oral progesterone, levonorgestrel intrauterine device(LNG-IUD) and combination oral contraceptive (COC). The patients were divided into two groups, maintenance therapy group and non-maintenance therapy group. Clinical characteristics, treatment regimens, prognosis, and pregnancy outcome were compared between the two groups.ResultsThe overall disease recurrence rate of the maintenance therapy group was significantly lower than that of the non-maintenance therapy group (P < 0.001). The recurrence rate of atypical endometrial hyperplasia and endometrial cancer in the maintenance therapy group were significantly lower than those in the non-maintenance group (P < 0.001). Maintenance therapy can reduce pregnancy rates and live birth rates. Maintenance therapy can protect the endometrium in patients treated with assisted reproductive technology (ART), greatly reducing the recurrence rate after ART (P<0.001).ConclusionMaintenance therapy plays a very important protective role in fertility-preserving treatment for patients with atypical endometrial hyperplasia and endometrial cancer, which could significantly reduce the risk of recurrence. It is recommended that patients could receive maintenance therapy as long as possible during the period from achieving complete response to pregnancy preparation if possible. It may provide recurrence-free survival long enough for childless young women to prepare for pregnancy in the future. It can also protect the endometrium of those who are preparing to use assisted reproductive technology, possibly by reducing the risk of recurrence by excessive stimulation with assisted reproductive drugs.
Highlights
Endometrial cancer (EC) is the most common gynecologic malignancy in developed countries [1]
Maintenance therapy refers to the continuous administration of low-dose progesterone to protect the endometrium after patients with atypical endometrial hyperplasia and endometrial cancer have achieved complete response through fertility-preserving treatment
Patients achieving complete response were assessed by at least two pathologists specializing in gynecological oncology, and all patients were evaluated by pelvic examination, ultrasound scan, and pelvic computed tomography, pelvic magnetic resonance imaging to confirm no tumor in the myometrium and no evidence of lymph node involvement or extrauterine metastasis
Summary
Endometrial cancer (EC) is the most common gynecologic malignancy in developed countries [1]. The clinical efficacy of fertility-preserving treatment for AEH and endometrioid endometrial cancer (EEC)has been confirmed. Complete response rates with oral high-dose progesterone treatment have achieved 60–98%. The median time from achieving complete response to the first recurrence is 14 months [7]. This predicts that many patients may face recurrence if they fail to conceive within the median time to recurrence. Maintenance therapy refers to the continuous administration of low-dose progesterone to protect the endometrium after patients with atypical endometrial hyperplasia and endometrial cancer have achieved complete response through fertility-preserving treatment. The maintenance therapy is aimed at maintaining a disease-free state as long as possible and prolong the fertility preservation duration. The study is intended to explore the clinical significance of maintenance therapy after fertility-preserving treatment for AEH and EC, providing references for standardization and optimization of fertility-preserving treatment for EC
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
