Risk Factors for Recurrence in Patients with Atypical Endometrial Hyperplasia and Endometrioid Adenocarcinoma after Fertility-Sparing Treatments.

Jie Yin,Ying Jin,Lingya Pan,Ying Shan,Yan Li,Shuai Ma,Yongxue Wang

doi:10.1158/1940-6207.capr-19-0399

Abstract

The aim of this work was to evaluate the risk factors for recurrence in young patients with atypical endometrial hyperplasia and early-stage endometrioid adenocarcinoma after fertility-sparing treatments (FST). A retrospective case-control study was designed. Patients with atypical endometrial hyperplasia and early-stage endometrioid adenocarcinoma who received FSTs from January 2010 to December 2017 were reviewed. All patients who met the inclusion criteria were divided into a recurrence group and a control group. Risk factors for recurrence- and disease-free survival were evaluated by logistic regression analysis and Cox regression analysis. A total of 127 patients were included, 53 patients in the recurrence group and 74 patients in the control group. No deaths occurred during the follow-up time. The rate of successful pregnancy was 62.5% in the control group and 20.5% in the recurrence group after complete remission (CR) of the primary disease. In a multivariate regression model, after adjusting for other factors, menstruation cycle, progestin type, and regular maintenance treatments after CR were the main risk factors for disease recurrence. Gonadotropin-releasing hormone agonist was mainly used to treat obese patients and was associated with longer progression-free survival (PFS) time compared with that in patients who received high-dose oral progestin such as megestrol acetate [risk ratio (RR), 2.158; 95% confidence interval (CI), 0.948-4.913]. Regular oral progestin also significantly prolonged the PFS time (RR, 4.726; 95% CI, 2.672-8.359). The progestin type used in treatment and regular maintenance treatment of young patients with atypical endometrial hyperplasia and early-stage endometrioid adenocarcinoma after CR might be correlated with disease recurrence.

Highlights

Endometrial cancer is the sixth most common cancer in women and the second most common gynecologic malignant tumor worldwide [1]; the rates of endometrial cancer are increasing in China [2]
The progestin type was divided into four groups: (i) medroxyprogesterone acetate (MPA) with/without a levonorgestrel-releasing intrauterine device (LNG-IUD) or letrozole; (ii) megestrol acetate (MA) with/without a LNG-IUD or letrozole; (iii) gonadotropinreleasing hormone agonist (GnRHa) with/ without a LNG-IUD or letrozole; and (iv) only a LNG-IUD
There was no significant correlation among age, gravidity, histology, and progestin type. This is the first study to evaluate the risk factors for endometrium atypical hyperplasia and early-stage endometrioid carcinoma recurrence after Fertility-sparing treatments (FST) based on clinical data from one tertiary hospital in China

Summary

Introduction

Endometrial cancer is the sixth most common cancer in women and the second most common gynecologic malignant tumor worldwide [1]; the rates of endometrial cancer are increasing in China [2]. Approximately 5% of patients with endometrioid adenocarcinoma are under 40 years old [6], and delayed childbearing leads to an increasing number of nulliparous women at the time of disease diagnosis. In these young patients, endometrioid adenocarcinoma or atypical hyperplasia usually presents with favorable prognostic characteristics, such as well-differentiated grade 1 lesions, no or minimal myometrial invasion, and high estrogen receptoralpha and progesterone receptor levels [7]. 75%–85% of patients with atypical hyperplasia and 50%–75% of patients with endometrioid adenocarcinoma are responsive to various therapies, including medroxyprogesterone, megestrol acetate, levonorgestrel

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