Long-term oncologic outcomes after fertility-sparing management using oral progestin for young women with endometrial cancer (KGOG 2002).
OBJECTIVE
To analyse the long-term oncologic outcomes of a fertility-sparing management using oral progestin in young women with endometrial cancer.


METHODS
We analysed 148 patients (age≤40 years) with stage IA, grade 1, endometrioid adenocarcinoma of the uterus who underwent fertility-sparing management using daily oral medroxyprogesterone acetate (MPA) or megestrol acetate (MA).


RESULTS
115 (77.7%) showed complete response (CR) to progestin treatment, and 35 (30.4%) of them experienced recurrence after median follow-up time of 66 months. The 5-year recurrence-free survival was 68% (95% confidence interval [CI], 58.5-76.9%). However, 33 patients (22.3%) who failed to achieve CR underwent definitive surgical management, and no one had recurrence after median follow-up time of 41 months. During progestin treatment and at the time of recurrence, no patient showed clinical progression of disease over stage IA. Body mass index (BMI) ≥25 kg/m(2) was the only significant factor associated with a failure to achieve CR (odds ratio [OR], 3.00; 95% CI, 1.35-6.66; P=0.007). Upon multivariate analysis, BMI≥25 kg/m(2) (OR, 2.14; 95% CI, 1.06-4.31; P=0.033) was significantly associated with a higher risk of recurrence and the use of MPA (compared to MA) (OR, 0.44; 95% CI, 0.22-0.88; P=0.021), maintenance treatment (OR, 0.22; 95% CI, 0.05-0.94; P=0.042) and pregnancy (OR, 0.25; 95% CI, 0.11-0.56; P=0.001) were significantly associated with a lower risk of recurrence.


CONCLUSIONS
Fertility-sparing management was highly effective and safe. BMI<25 kg/m(2), MPA (compared to MA), maintenance treatment and pregnancy were associated with higher possibility of long-term success.
Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Jeong-Yeol
JY
Park
Dae-Yeon
DY
Kim
Jong-Hyeok
JH
Kim
Yong-Man
YM
Kim
Kyu-Rae
KR
Kim
Young-Tak
YT
Kim
Seok Ju
SJ
Seong
Tae-Jin
TJ
Kim
Jae Weon
JW
Kim
Seok Mo
SM
Kim
Duk-Soo
DS
Bae
Joo-Hyun
JH
Nam
D000284:Administration, Oral; D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage*; D018269:Carcinoma, Endometrioid / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D015331:Cohort Studies; D016889:Endometrial Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D005260:Female; D059247:Fertility Preservation; D005500:Follow-Up Studies; D006801:Humans; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage*; D019290:Megestrol Acetate / Q000008:administration & dosage*; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D011247:Pregnancy; D011379:Prognosis; D015996:Survival Rate; D055815:Young Adult
D018931:Antineoplastic Agents, Hormonal; D017258:Medroxyprogesterone Acetate; D019290:Megestrol Acetate