Effects of pathological assessment of endometrial tissue in fertility-sparing treatment with progestin for endometrial carcinoma of stage Ⅰ a and complex atypical hyperplasia / 中华妇产科杂志

ABSTRACT

Objective To assess the efficacy and pathological change of fertility-sparing treatment with progestin for endometrial carcinoma (EC) of stage Ⅰ a and complex atypical hyperplasia (CAH) and to observe the prognosis of the treatment.Methods Nine EC patients of stage Ⅰ a and 21 CAH patients aged under 40 years who desired childbearing and retaining their fertility were enrolled into this study.All patients were given a daily oral high-dose of progestin with duration of treatment ranging from 6 to 9 months.Diagnostic curettage was performed every 3 months as a modality for seeing the histologic change of neoplastic tissues and endometrial tissue.A careful and long-term follow-up is necessary for patients with complete response (CR).Results During the first period of fertility-sparing management,according to histologic change,5 EC patients and 18 CAH patients showed CR with no evidence of endometrial adenocarcinoma or hyperplasia,2 EC patients and 2 CAH patients showed partial response with a regression to complex or simple hyperplasia without atypia,2 EC patients and 1 CAH patient showed stable disease or progressive disease.Accordingly,a total of 26 patients showed CR (26 of 30 patients).The median time to CR was 6 months (range,3 to 21 months) of progestin treatment.The median follow-up time was 55.5 months (range,24 to 104 months) and all patients were alive.During follow-up,among the 26 patients with CR,3 of 6 EC patients achieved CR recurred disease after a median time interval of 10 months (range,6 to 51 months),7 of 20 CAH patients achieved CR had recurrent disease after a median time interval of 12 months (range,6 to 55 months).Four of 7 CAH with recurrent disease achieved CR to progestin retreatment.Eight of 26 patients achieved CR continued a further 3 or 6 months of consolidation therapy,3 of them had recurrent disease,the remaining 18 stopped progesterone treatment after CR and 7 patients had recurrent disease; there was no significant statistical difference between the two groups (P=1.000).EC patients succeeded in 4 pregnancies,CAH patients succeeded in 10 pregnancies,they gave birth to 16 healthy babies in all.Conclusions EC of stage Ⅰ a and CAH had slow progression of symptoms.Progestin treatment in EC of stage Ⅰ a and CAH patients was effective.A careful and long-term follow-up is required because of the substantial high rate of recurrence.Progestin re-treatment in most patients with recurrent endometrial cancer is effective and safe.