Curative Effect And Pregnancy Outcomes In Patients Of Fertility-sparing Therapy In Endometrial Adenocarcinoma And Endometrial Atypical Hyperplasia

Objective:To analyze the curative effect, prognosis and pregnancy outcomes of fertility-sparing therapy in patients diagnosed as endometrial adenocarcinoma and endometrial atypical hyperplasia.Methods:We collected the complete clinical and pathological records and follow-up information of patients diagnosed as ednometrial adenocarcinoma and ednometrial atypical hyperplasia who received fertility-sparing therapy in the Women’s Hosptital School of Medicine, Zhejiang University from 1 January 2001 to 31 December 2015 with a total of 36 patients, and to retrospective analyze the relevant parameters by Cox regression analysis.Results:A total of 26 in 36 patients achieved pathological complete remission; the complete remission rate was 72.2%. The complete remission rate in endometrial atypical hyperplasia group was 80%, and it’s higher than the endometrial adenocarcinoma group which was 54.5%, but no significant difference between them (P>0.05). The complete remission rate in medroxyprogesterone acetate group was 81.5%, and it’s higher than the megestrol acetate group which was 44.4%, but no significant difference between them (P>0.05). A total of 9 in 26 patients got recurrence after complete remission; the recurrence rate was 34.6%.6 patients received fertility-sparing therapy again; the complete remission rate was 100%. COX regression analysis showed that the obesity group was at higher risk of recurrence when compared to no obesity group (P<0.05). The spontaneous pregnancy group was at higher risk of recurrence when compared to maintain therapy group (P<0.05). There was no significant difference between the assisted reproduction technology group and no assisted reproduction technology group (P>0.05). There were 7 patients achieved successful pregnancy and a total of 5 live births till the end of follow-up.Conclusion:1. Fertility-sparing therapy for adenocarcinoma and atypical hyperplasia of the endometrium in young women can achieve a high complete remission rate.2. Patients who got recurrence after complete remission can receive further fertility-sparing therapy after strict evaluation, and they still can obtain satisfactory curative effect.3. Obesity and no maintain therapy were the risk factors of recurrence after complete remission; assisted reproduction technology would not increase the risk of recurrence.