title: [Effects of pathological assessment of endometrial tissue in fertility-sparing treatment with progestin for endometrial carcinoma of stage I a and complex atypical hyperplasia].
abstract: OBJECTIVE
  To assess the efficacy and pathological change of fertility-sparing treatment with progestin for endometrial carcinoma (EC) of stage I a and complex atypical hyperplasia (CAH) and to observe the prognosis of the treatment.
  
  
  METHODS
  Nine EC patients of stage I a and 21 CAH patients aged under 40 years who desired childbearing and retaining their fertility were enrolled into this study. All patients were given a daily oral high-dose of progestin with duration of treatment ranging from 6 to 9 months. Diagnostic curettage was performed every 3 months as a modality for seeing the histologic change of neoplastic tissues and endometrial tissue. A careful and long- term follow- up is necessary for patients with complete response (CR).
  
  
  RESULTS
  During the first period of fertility-sparing management, according to histologic change, 5 EC patients and 18 CAH patients showed CR with no evidence of endometrial adenocarcinoma or hyperplasia, 2 EC patients and 2 CAH patients showed partial response with a regression to complex or simple hyperplasia without atypia, 2 EC patients and 1 CAH patient showed stable disease or progressive disease. Accordingly, a total of 26 patients showed CR (26 of 30 patients). The median time to CR was 6 months (range, 3 to 21 months) of progestin treatment. The median follow-up time was 55.5 months (range, 24 to 104 months) and all patients were alive. During follow-up, among the 26 patients with CR, 3 of 6 EC patients achieved CR recurred disease after a median time interval of 10 months (range, 6 to 51 months), 7 of 20 CAH patients achieved CR had recurrent disease after a median time interval of 12 months (range, 6 to 55 months). Four of 7 CAH with recurrent disease achieved CR to progestin re-treatment. Eight of 26 patients achieved CR continued a further 3 or 6 months of consolidation therapy, 3 of them had recurrent disease, the remaining 18 stopped progesterone treatment after CR and 7 patients had recurrent disease; there was no significant statistical difference between the two groups (P = 1.000). EC patients succeeded in 4 pregnancies, CAH patients succeeded in 10 pregnancies, they gave birth to 16 healthy babies in all.
  
  
  CONCLUSIONS
  EC of stage I a and CAH had slow progression of symptoms. Progestin treatment in EC of stage I a and CAH patients was effective. A careful and long-term follow-up is required because of the substantial high rate of recurrence. Progestin re-treatment in most patients with recurrent endometrial cancer is effective and safe.
authors.affiliation: Department of Pathology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China.
authors.forename: Qinglin
authors.initials: Q
authors.lastname: Gong
authors.affiliation: Email: chenxiaod@zju.edu.cn.
authors.forename: Xiaoduan
authors.initials: X
authors.lastname: Chen
authors.forename: Xing
authors.initials: X
authors.lastname: Xie
mesh_terms: D000368:Aged; D018269:Carcinoma, Endometrioid / Q000188:drug therapy* / Q000473:pathology; D004714:Endometrial Hyperplasia / Q000188:drug therapy*; D016889:Endometrial Neoplasms / Q000188:drug therapy / Q000473:pathology; D005260:Female; D005298:Fertility; D059247:Fertility Preservation; D006801:Humans; D009367:Neoplasm Staging; D059351:Organ Sparing Treatments; D011372:Progestins / Q000008:administration & dosage*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D011372:Progestins