Efficacy And Pregnancy Outcome Analysis Of Fertility-preserving Treatment In Patients With Endometrial Atypical Hyperplasia

Objective:To analyze the efficiency and pregnancy outcomes of progestin treatment in patients with endometrial atypical hyperplasia.Methods:We retrospectively collected the clinicopathological data and follow-up information of patients with endometrial atypical hyperplasia who received progestin treatment in Shengjing Hospital from January 2013 to December 2017,and to retrospective analysis the relevant parameters.Results:This study included 96 patients with a median age of 32(18-40)years old and a median BMI of 28.1(18.3-44.1)kg/m~2.Among them,70 patients achieved complete remission,with a complete remission rate of 72.9%.The complete remission rate in the megestrol acetate group was higher than in the medroxyprogesterone acetate group(74.5%vs.71.1%);and the complete remission rate in the BMI?28 kg/m~2 group was lower than in the BMI<28 kg/m2 group(67.3%vs.80.5%),but the differences were not statistically significant(P>0.05).Of the 70 patients with complete remission,15 patients relapsed,the recurrence rate was 21.4%,33 patients obtained pregnancy,and the pregnancy rate was 47.1%.Logistic regression analysis showed that pregnancy was easier to obtain for patients younger than 35 years old(52.7%vs.26.7%,P=0.047).The risk of recurrence was higher in the group with BMI?28 kg/m~2 compared with the group with BMI<28 kg/m~2(31.4%vs.11.4%,P=0.022),and it is difficult to obtain pregnancy(25.7%vs.68.6%,P<0.001).There is no difference in the risk of recurrence between the natural conception group and the assisted reproductive technology group(23.3%vs.20.0%,P>0.05),but the assisted reproductive technology group has a significantly higher pregnancy rate(57.5%vs.33.3%,P=0.046).The Kaplan-Meier survival curve found that most patients had complete remission within 12 months,pregnancy occurred within 12 months after complete remission,and most of the relapses occurred within 2 years after complete remission.The 2-year recurrence-free rate was about 78.7%.Conclusions:(1)Oral progestin for fertility-sparing treatment in patients with endometrial atypical hyperplasia is efficient.(2)Patients with BMI?28 kg/m~2 are more likely to recurrence,and not easy to abtain pregnancy.(3)Assisted reproductive technology can increase the pregnancy rate and improve pregnancy outcomes.(4)Therefore,it is recommended that patients undergo weight management during treatment and follow-up,and assisted reproductive technology is benefit for improving pregnancy outcomes after complete remission.