A Prospective Study Of Fertility-preserving Therapy In Patients With Endometrial Atypical Hyperplasia And Early Endometrial Carcinoma

Objective: To study the treatment,follow-up and reproductive guidance of retaining reproductive function in patients with atypical hyperplasia of endometrium and early endometrial carcinoma.Methods: From September 2016 to February 2019,24 young patients with atypical hyperplasia of endometrium and early endometrial carcinoma were randomly divided into two groups.In group A,12 patients were treated with hysteroscopic resection of focus combined with oral progesterone therapy(EAH9,EEC3,),B group,12 patients with progesterone alone(EAH9,EEC3).Close follow-up and statistical methods were used.Prospective analysis of the two groups of patients with complete remission rate,pregnancy rate,safety and factors affecting complete remission,to guide patients to achieve the purpose of fertility.Results:The complete remission rate was 83% in group A and 33% in group B.the complete remission rate in group A was higher than that in group B,and there was significant difference between the two groups(P < 0.05).There was no significant difference in the time of obtaining CR and the course of treatment(P > 0.05).During the follow-up period,there were no serious adverse events such as thrombosis,severe liver and kidney dysfunction,and 96% of the patients did not progress beyond stage IA during treatment and follow-up.The survival rate was 100% and the recurrence rate was 8% in both groups.There was no significant difference in(PFS)between the two groups.According to the analysis of the related factors affecting complete remission,the body mass index(BMI)? 30 was closely related to the lack of complete remission,and there was statistical significance(P < 0.05).The pregnancy rate was 25% in group A and 8% in group B.of the 10 patients with complete remission and fertility desire,4(40%)were pregnant successfully,of which 2(20%)received assisted reproductive technology.Conclusion: It is effective and safe to retain reproductive function in patients with atypical hyperplasia of endometrium and early endometrial carcinoma.The complete remission rate of hysteroscopic focus resection combined with progesterone therapy is higher than that of progesterone alone.It is suggested that hysteroscopic focal resection combined with progesterone therapy is one of the important methods to preserve reproductive function.Obesity(BMI ? 30)is a risk factor for complete remission and is statistically significant.Weight control should be recommended during treatment follow-up.Patients should get pregnant as soon as possible after complete remission.The acceptance of assisted reproductive technology is helpful to improve the pregnancy rate and achieve the goal of fertility.