title: Does hormonal therapy for fertility preservation affect the survival of young women with early-stage endometrial cancer?
abstract: The incidence of endometrial cancer among young women is increasing. Some patients with low-grade endometrial cancer receive hormone therapy (HT) before surgery to preserve fertility. It is unclear whether this adversely affects survival.
  
  
  
  Patients with localized, low-grade endometrial cancer who were aged <45 years were selected from the Surveillance, Epidemiology, and End Results database between 1993 and 2012. Propensity score matching was used to select comparable groups receiving HT or primary surgery. Cancer-specific and overall survival were measured using Kaplan-Meier methods. Hazard ratios and 95% confidence intervals (95% CIs) were estimated using Cox models adjusted for age, period of diagnosis, marital status, race, tumor grade, morphology, and previous radiotherapy.
  
  
  
  A total of 6339 women were included in the current study cohort, 161 of whom initially received HT and 6178 of whom received primary surgery. After 15 years of follow-up, all-cause mortality did not differ between the groups (HT group: 14.1% [95% CI, 6.7%-28.4%] and propensity score-matched primary surgery group: 9.3% [95% CI, 4.1%-20.5%]). Cancer-specific mortality appeared higher in patients treated with HT compared with those treated with primary surgery (9.2% [95% CI, 3.4%-24.0%] vs 2.1% [95% CI, 1.5%-2.8%]). However, this difference was driven by 3 late deaths in the HT group. Sensitivity analyses using a broader definition of cancer-specific mortality provided no statistical evidence of a survival difference between the treatment groups. The hazard ratio for the overall risk of death was 1.45 (95% CI, 0.44-4.74).
  
  
  
  Based on this population-based cohort, young patients with low-grade endometrial cancer appear to have excellent survival, regardless of the primary therapy chosen (HT vs primary surgery). The current selection of patients for HT to preserve fertility, which is managed carefully by experienced clinicians, does not appear to significantly worsen clinical outcomes. Cancer 2017;123:1545-1554. © 2017 American Cancer Society.
authors.affiliation: Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada.|Department of Oncology, McGill University, Montreal, Quebec, Canada.
authors.forename: Zoë R
authors.initials: ZR
authors.lastname: Greenwald
authors.affiliation: Department of Obstetrics and Gynecology, McGill University, Royal Victoria Hospital-Glen Site, Montreal, Quebec, Canada.
authors.forename: Lina N
authors.initials: LN
authors.lastname: Huang
authors.affiliation: Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada.|Department of Oncology, McGill University, Montreal, Quebec, Canada.|Department of Urology, McGill University Health Center, Montreal, Quebec, Canada.
authors.forename: Michel D
authors.initials: MD
authors.lastname: Wissing
authors.affiliation: Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada.|Department of Oncology, McGill University, Montreal, Quebec, Canada.
authors.forename: Eduardo L
authors.identifier: 0000-0002-4409-8084
authors.initials: EL
authors.lastname: Franco
authors.affiliation: Department of Oncology, McGill University, Montreal, Quebec, Canada.|Division of Gynecologic Oncology and Lady Davis Research Institute, Jewish General Hospital, Montreal, Quebec, Canada.
authors.forename: Walter H
authors.initials: WH
authors.lastname: Gotlieb
mesh_terms: D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D018269:Carcinoma, Endometrioid / Q000188:drug therapy* / Q000401:mortality; D002423:Cause of Death; D015331:Cohort Studies; D016889:Endometrial Neoplasms / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D059247:Fertility Preservation / Q000379:methods*; D006801:Humans; D007044:Hysterectomy; D053208:Kaplan-Meier Estimate; D008525:Medroxyprogesterone / Q000627:therapeutic use; D017258:Medroxyprogesterone Acetate / Q000627:therapeutic use; D019290:Megestrol Acetate / Q000627:therapeutic use; D060787:Neoplasm Grading; D057216:Propensity Score; D016016:Proportional Hazards Models; D018426:SEER Program; D013997:Time Factors; D014481:United States
chemical_list: D018931:Antineoplastic Agents, Hormonal; D017258:Medroxyprogesterone Acetate; D008525:Medroxyprogesterone; D019290:Megestrol Acetate
keywords: Epidemiology; Surveillance; and End Results (SEER) program; endometrial neoplasms; epidemiology; hysterectomy; progestin; survival