早期子宫内膜癌患者实现生育保留激素治疗后复发的风险因素

Risk factors for the recurrence in patients with early endometrioid endometrial cancer achieving complete remission for fertility-sparing hormonal treatment

GYNECOLOGIC ONCOLOGY

影响因子:4.1

分区:医学2区 Top / 妇产科学1区肿瘤学2区

发表日期:2024 Dec

作者: Eun Bi Jang, A Jin Lee, Kyeong A So, Sun Joo Lee, Ji Young Lee, Tae Jin Kim, Eunhyang Park, Soon-Beom Kang, Seung-Hyuk Shim

DOI: 10.1016/j.ygyno.2024.09.015

摘要

本研究旨在评估通过生育保留激素治疗（FST）达到完全缓解（CR）的早期子宫内膜样子宫内膜癌（EC）患者的复发风险因素。我们回顾性分析在两家机构接受FST的疑似I期和一级子宫内膜样EC患者。使用的激素治疗包括甲羟孕酮（MPA）和左炔诺孕酮释放宫内节育器（LNG-IUD）。未立即怀孕的患者持续使用LNG-IUD以维持治疗。采用Cox回归分析识别影响无复发生存期（RFS）的临床病理变量。在178名接受FST的子宫内膜样EC患者中，142名（79.8%）达到CR。达到CR的中位时间为10个月（范围1-34），FST的中位持续时间为14个月（范围3-49）。在中位随访44个月（范围6-143）期间，59.9%（85/142）患者发生复发，CR后中位RFS为14个月（范围1-123）。多变量分析显示，年龄>35岁（风险比（HR）=1.892，95%置信区间（CI）：1.224-2.923；P<0.05）和首次CR后未怀孕（HR=0.203，95% CI：0.093-0.444；P<0.05）显著与RFS相关。年龄较大及未怀孕可能是CR后复发的风险因素，建议这些患者进行严格随访，包括影像学和组织学检查，以早期检测复发。

Abstract

This study aimed to assess the recurrence risk factors in patients with early-stage endometrioid endometrial cancer (EC) who achieved a complete response (CR) through fertility-sparing hormonal treatment (FST).We retrospectively analyzed patients who received FST for presumed stage IA and grade 1 endometrioid EC at two institutions. Medroxyprogesterone (MPA)- and levonorgestrel-releasing intrauterine devices (LNG-IUD) were used concurrently. Maintenance therapy involved maintaining the LNG-IUDs in situ for those who did not attempt to conceive immediately after achieving CR. Cox regression analysis was used to identify clinicopathological variables for recurrence-free survival (RFS) following CR.Among 178 patients with endometrioid EC who received FST, 142 (79.8 %) achieved CR. The median time to achieve CR and the median FST duration were 10 months (range 1-34) and 14 months (range 3-49), respectively. During the median follow-up period of 44 months (range 6-143), 59.9 % (85/142) of patients had recurrence, with a median RFS of 14 months (range 1-123) after CR. In multivariable analysis, age > 35-years (hazard ratio (HR) 1.892, 95 % confidence interval (CI) 1.224-2.923; P < 0.05) and pregnancy after the first CR (HR 0.203, 95 % CI 0.093-0.444; P < 0.05) were significantly associated with RFS.Older age and non-pregnancy status may be risk factors for recurrence after CR. Therefore, patients with these conditions should undergo stringent follow-up, including imaging and histological examinations, to detect recurrence after CR.