Characteristics of progestin-insensitive early stage endometrial cancer and atypical hyperplasia patients receiving second-line fertility-sparing treatment
Zhou Shuang, Xu Zhiying, Yang Bingyi, Guan Jun, Shan Weiwei, Shi Yue, Chen Xiaojun,
소속 상세정보
( Zhou Shuang )
Fudan University Obstetrics and Gynecology Hospital Department of Gynecology
( Xu Zhiying )
Fudan University Obstetrics and Gynecology Hospital Department of Gynecology
( Yang Bingyi )
Fudan University Obstetrics and Gynecology Hospital Department of Gynecology
( Guan Jun )
Fudan University Obstetrics and Gynecology Hospital Department of Gynecology
( Shan Weiwei )
Fudan University Obstetrics and Gynecology Hospital Department of Gynecology
( Shi Yue )
Fudan University Obstetrics and Gynecology Hospital Department of Gynecology
( Chen Xiaojun )
Fudan University Obstetrics and Gynecology Hospital Department of Gynecology
Abstract
Objective: This study investigated the characteristics of progestin-insensitive endometrioid endometrial cancer (EEC) and atypical endometrial hyperplasia (AEH) patients receiving fertility-sparing treatments and assessed the therapeutic effects of second-line fertility-preserving treatments.
Methods: Three hundred and thirty-eight patients with EEC (n=75) or AEH (n=263) receiving fertility-preserving treatment were retrospectively analyzed. ‘Progestin-insensitive’ was defined as meeting one of the following criteria: 1) presented with progressed disease at any time during conservative treatment, 2) remained with stable disease after 7 months of treatment, and/or 3) did not achieve complete response (CR) after 10 months of treatment. Clinical characteristics and treatment results of progestin-insensitive patients receiving second-line treatment and those of progestin-sensitive patients were compared.
Results: Eight-two patients (59 AEH and 23 EEC) were defined as progestin-insensitive and 256 as progestin-sensitive. In multivariate analysis, body mass index ≥28.0 kg/m2 (odds ratio [OR]=1.898) and lesion size >2 cm (OR=2.077) were independent predictors of progestin-insensitive status. Compared to AEH patients, progestin-insensitive EEC patients had poorer second-line treatment responses (28-week cumulative CR rate after changing second-line treatment, 56.3% vs. 85.4%, p=0.011). No statistical difference was found in CR rate among different second-line treatments.
Conclusion: Obesity and larger lesion size were independent risk factors associated with progestin-insensitive status. In progestin-insensitive patients receiving second-line treatment, EEC patients had lower CR rate comparing with AEH patients. Further study with larger sample size is needed to evaluate efficacy of different second-line treatments for progestin insensitive patients.
키워드
Endometrial Hyperplasia; Endometrial Neoplasms; Conservative Treatment
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