[Outcome analysis of conservative treatment of well-differentiated endometrial adenocarcinoma and severe atypical hyperplasia in young women].
OBJECTIVE
To evaluate the effect of hormonal therapy on well-differentiated endometrial adenocarcinoma and severe atypical hyperplasia in young women aged 35 years and younger.


METHODS
We retrospectively studied the clinical characteristics of 25 patients under 35 years of age (average: 28.6) diagnosed with well-differentiated endometrial adenocarcinoma or severe atypical hyperplasia, who were treated with progestin in Peking Union Medical College Hospital from 1991 to 2005. According to pathologic results, 25 patients were divided into two groups: 8 cases of endometrial carcinoma and 17 cases of severe atypical hyperplasia. In the endometrial carcinoma group, pelvic ultrasound, MRI, chest X-ray and serum CA(125) were used in pretreatment evaluation. Progesterone receptors were examined with immunohistochemical method. All patients received dilation and curettage of endometrium every 1-6 months as an assessment of treatment results. For chemotherapy, most of them were treated with medroxyprogesterone acetate.


RESULTS
Six cases (6/7) in endometrial carcinoma group, and 17 cases (100%) in severe atypical hyperplasia group responded to treatment respectively; among them, 5 cases (5/7) and 14 cases (82%) had complete response, which was defined as the absence of any carcinoma or hyperplasia on endometrial samplings; one case (1/5) and 3 cases (21%) recurred within 6 to 30 months after their complete response. Follow-up on 14 patients with complete response, and the desire for childbearing showed that none of the 4 cases of endometrial carcinoma had conceived a pregnancy and 4 (40%) patients had pregnancy for totally 7 times of 10 cases of severe atypical hyperplasia. Three patients delivered full-term fetuses with induced ovulation, one of whom had artificial abortion 3 times after her delivery. One patient was lost to follow up after her spontaneous pregnancy.


CONCLUSIONS
Progestin therapy is a good choice for young women having fertility desires diagnosed with well-differentiated endometrial adenocarcinoma or severe atypical hyperplasia. Endometrial carcinoma patients should be selected carefully before therapy. Pregnant rate is not satisfactory after conservative treatment. Assistant reproductive technology is potentially helpful to improve pregnant rate of patients responded to progestin therapy.
Yu
Mei
M
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China.
Shen
Keng
K
Yang
Jia-xin
JX
Huang
Hui-fang
HF
Wu
Ming
M
Pan
Ling-ya
LY
Lang
Jing-he
JH
Lian
Li-juan
LJ
D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D018269:Carcinoma, Endometrioid / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D004714:Endometrial Hyperplasia / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D016889:Endometrial Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D011247:Pregnancy; D018873:Pregnancy Rate; D011372:Progestins / Q000627:therapeutic use*; D011980:Receptors, Progesterone / Q000378:metabolism; D012189:Retrospective Studies; D016896:Treatment Outcome
D018931:Antineoplastic Agents, Hormonal; D011372:Progestins; D011980:Receptors, Progesterone