title: Prognostic factors of oncological and reproductive outcomes in fertility-sparing treatment of complex atypical hyperplasia and low-grade endometrial cancer using oral progestin in Chinese patients.
abstract: OBJECTIVE
  To evaluate the efficacy and fertility outcomes of progestin treatment for complex atypical hyperplasia (CAH)/grade I endometrial cancer (G1EC) in Chinese patients (≤40years old).
  
  
  METHODS
  Women ≤40years old who were treated with progestin for CAH or G1EC were identified from 9 provinces of China. The time to achieve complete response (CR) and the time from CR to recurrence or pregnancy were censored for patients without events and were analyzed for associations between patient and treatment characteristics.
  
  
  RESULTS
  Thirty-two patients were included: 13 with CAH and 19 with G1EC. Nine patients exhibited elevated serum HbA1C before treatment. After a mean follow-up of 32.5months, the CR rate was 84.4%. Patients who exhibited elevated HbA1C were more likely to experience CR, while those with polycystic ovarian syndrome (PCOS) exhibited the opposite outcome (p=0.01, 0.03). Nine of 21 patients experienced clinical pregnancies. Eight patients underwent assisted reproductive technology (ART). Five patients had newborn infants. Patients undergoing ART were more likely to become pregnant (p=0.04).
  
  
  CONCLUSIONS
  Oral progestin is an effective fertility-sparing treatment for women with CAH/G1EC in China. Patients with elevated HbA1C receiving both metformin and progestin were more likely to achieve CR, whereas those with PCOS were not. ART is a good choice for clinical pregnancy after treatment.
authors.affiliation: Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China.
authors.forename: Rong
authors.initials: R
authors.lastname: Zhou
authors.affiliation: Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China.
authors.forename: Qun
authors.initials: Q
authors.lastname: Lu
authors.affiliation: Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China. Electronic address: wangjianliu@pkuph.edu.cn.
authors.forename: Jianliu
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China.
authors.forename: Yali
authors.initials: Y
authors.lastname: Miao
authors.affiliation: Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China.
authors.forename: Shijun
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China.
authors.forename: Zhiqi
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Zhao
authors.affiliation: Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China.
authors.forename: Lihui
authors.initials: L
authors.lastname: Wei
mesh_terms: D000284:Administration, Oral; D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D002681:China; D004714:Endometrial Hyperplasia / Q000097:blood / Q000188:drug therapy* / Q000473:pathology*; D016889:Endometrial Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000473:pathology*; D005260:Female; D059247:Fertility Preservation; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008687:Metformin / Q000627:therapeutic use; D060787:Neoplasm Grading; D011085:Polycystic Ovary Syndrome / Q000150:complications; D011247:Pregnancy; D018873:Pregnancy Rate; D011372:Progestins / Q000008:administration & dosage / Q000627:therapeutic use*; D011379:Prognosis; D027724:Reproductive Techniques, Assisted; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018931:Antineoplastic Agents, Hormonal; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D008687:Metformin; D011372:Progestins; C517652:hemoglobin A1c protein, human
keywords: Endometrial atypical hyperplasia; Endometrial cancer; Fertility-sparing treatment; Metformin; Pcos; Progestin therapy