Oncologic and reproductive outcomes after fertility-sparing management with oral progestin for women with complex endometrial hyperplasia and endometrial cancer.
OBJECTIVE
To investigate the oncologic and reproductive outcomes after progestin treatment of complex endometrial hyperplasia (CEH) and grade 1 endometrial carcinoma (EC).


METHODS
In a retrospective study, data were obtained for patients aged 20-42years with CEH or grade 1 EC at presumed stage IA (without myometrial invasion) who wished to preserve fertility and were treated at the Peking Union Medical College Hospital, China, between January 1, 2000, and December 31, 2011. Patients had received oral medroxyprogesterone acetate (250-500mg/day) or megestrol acetate (160-480mg/day) for at least 6months. Response to progestin treatment was assessed histologically.


RESULTS
Among 53 included patients, 39 (74%) achieved complete response after a median period of 6 (3-24) months. Complete response was less frequent among obese than nonobese patients (4/12 [33%] vs 35/41 [85%]; P=0.001). Disease recurrence was recorded in 10 (26%) patients with complete response; the 5-year recurrence-free survival rate was 71%. Among the 33 patients who retained a desire to conceive, 17 (52%) became pregnant.


CONCLUSIONS
Fertility-sparing management with oral progestin is effective. Obesity is associated with a lower probability of long-term success.
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Obstetrics and Gynecology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
Ming
M
Chen
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Ying
Y
Jin
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Yan
Y
Li
Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Yalan
Y
Bi
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Ying
Y
Shan
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address: panly@pumch.cn.
Lingya
L
Pan
D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage*; D002681:China; D018572:Disease-Free Survival; D004714:Endometrial Hyperplasia / Q000188:drug therapy*; D016889:Endometrial Neoplasms / Q000188:drug therapy*; D005260:Female; D005298:Fertility / Q000187:drug effects; D059247:Fertility Preservation / Q000379:methods*; D006801:Humans; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage; D019290:Megestrol Acetate / Q000008:administration & dosage; D009364:Neoplasm Recurrence, Local; D009765:Obesity / Q000150:complications; D011247:Pregnancy; D011372:Progestins / Q000008:administration & dosage*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
D018931:Antineoplastic Agents, Hormonal; D011372:Progestins; D017258:Medroxyprogesterone Acetate; D019290:Megestrol Acetate
Complex endometrial hyperplasia; Conservative treatment; Endometrial carcinoma; Fertility-sparing treatment; Progestin therapy