子宫内膜非典型增生及子宫内膜癌患者保留生育功能治疗的临床研究

目的: 探讨子宫内膜非典型增生(complex atypical hyperplasia, CAH)及子宫内膜癌(endometrial cancer, EC)患者保留生育功能治疗的效果及妊娠结局。方法: 回顾性分析2009年1月至2021年9月北京大学人民医院进行保留生育功能治疗的EC患者及CAH患者共191例, 对患者的肿瘤缓解、复发及妊娠情况进行分析。结果: (1) 疗效及相关因素: 总体完全缓解(complete response, CR)率为86.1%(161/187例), CAH组的CR率显著高于EC组(92.7% vs. 79.1%, P=0.007), Logistic回归分析显示, CAH组的CR率更高(OR=2.786, P=0.035);(2)复发率: 总体复发率为19.3%(31/161例), EC组显著高于CAH组(26.4% vs. 13.5%, P=0.039), 中位复发时间为22.5(9.0, 50.0)个月; (3)复发相关因素: 病理类型为EC(χ²=4.880, P=0.027)、未使用二甲双胍(χ²=7.075, P=0.008)、治疗达CR的时间>7个月(χ²=6.204, P=0.013)及未妊娠(χ²=6.765, P=0.009)患者的累积复发率显著更高; (4)妊娠结局及相关因素: 达到CR的患者中共有108例有生育意愿, 妊娠率为41.7%(45/108例), 生育率为34.3%(37/108), EC组的生育率显著低于CAH组(28.6% vs. 42.4%, P=0.045), 中位妊娠时间为10.50(5.75, 33.25)个月。既往有妊娠史(OR=9.468, P < 0.001)和接受辅助生殖治疗(OR=7.809, P < 0.001)患者的妊娠率更高。结论: EC及CAH患者进行保留生育功能治疗的疗效肯定, 可以获得较高的疾病缓解率和一定的妊娠分娩率, 但仍存在复发率高及生育率低的问题。

Clinical analysis of fertility-sparing therapy of patients with complex atypical hyperplasia and endometrial cancer

Objective: To analyze the efficacy and prognosis of fertility-sparing therapy of the patient with complex atypical hyperplasia (CAH) and endometrial cancer (EC). Methods: Clinical data of 191 EC and CAH patients who received fertility-sparing therapy in Peking University People's Hospital between January 2009 and September 2021 were recruited retrospectively. Outcomes of remission, recurrence and pregnancy were analyzed. Results: (1) Efficacy and efficacy-related factors: The complete response (CR) rate was 86.1% (161/187) for all the patients, and the CR rate of the CAH patients were higher than that of the EC patients (92.7% vs. 79.1%, P=0.007), the CR rate was significant higher in the CAH patients (OR=2.786, P=0.035). (2) The recurrence rate was 19.3% (31/161), and the recurrence rate of the EC patients were much higher than that of the CAH patients (26.4% vs. 13.5%, P=0.039). The median recurrence time was 22.5 (9.0, 50.0) months. (3) The high risk factors of recurrence were pathological type of EC (χ²=4.880, P=0.027), without the use of metfor-min (χ²=7.075, P=0.008), longer time to complete remission (>7 months) (χ²=6.204, P=0.013), and no pregnancy (χ²=6.765, P=0.009). (4) Results of pregnancy and related factors: Among the patients who achieved CR, 108 patients had fertility willing with the pregnancy rate of 41.7% (45/108), and the live birth rate was 34.3% (37/108). The live birth rate was lower in EC than that in the CAH patients (28.6% vs. 42.4%, P=0.045). The median time to achieve pregnancy was 10.50 (5.75, 33.25) months. The pregnancy rate was significant higher in the patients with pregnancy history (OR=9.468, P < 0.001) and in those who received assisted reproductive therapy (OR=7.809, P < 0.001). Conclusion: Fertility-sparing therapy of CAH and EC patients is effective resulting in high disease remission and certain pregnancy. However, the high recurrence rate and low pregnancy rate are still key problems for EC and CAH patients, therefore close monitoring and follow-up are indicated.