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Pregnancy and oncologic outcomes after fertility-sparing management for early stage endometrioid endometrial cancer
  1. Su Hyun Chae1,
  2. Seung-Hyuk Shim1,
  3. Sun Joo Lee1,
  4. Ji Young Lee1,
  5. Soo-Nyung Kim1 and
  6. Soon-Beom Kang2
  1. 1 Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Korea
  2. 2 Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Konkuk University Medical Center, Seoul, Korea
  1. Correspondence to Seung-Hyuk Shim, Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul 05030, Korea; nastassja{at}hanmail.net; Soon-Beom Kang, Gynecologic Cancer Center, Department of Obstetrics and Gynecology, Konkuk University Medical Center, Seoul, Korea; 20120097{at}kuh.ac.kr

Abstract

Objective Hormonal management is an alternative treatment for preserving fertility in patients with presumed early stage endometrioid endometrial cancer. This study aimed to define the pregnancy and oncologic outcomes and factors of successful conception after hormone therapy for endometrioid endometrial cancer.

Methods We retrospectively analyzed patients presumed to have stage IA, grade 1–2 endometrioid endometrial cancer who underwent fertility-sparing treatment. Concurrent medroxyprogesterone and levonorgestrel-release intra-uterine devices were used for treatment. The pregnancy outcomes and oncologic outcomes were compared between the pregnant and non-pregnant groups.

Results Seventy-one patients presumed to have stage IA, grade 1–2 endometrioid endometrial cancer had complete remission, and 49 of them tried to conceive. Twenty-two (44.9%) patients became pregnant; the total number of pregnancies was 30. These pregnancies resulted in seven abortions (23.3%), one pre-term birth (3.3%), and 20 full-term births (66.6%). The total live birth rate was 66.6 % (20/30). The median duration of hormonal treatment was 11.9 months (range 4–49) and 12.0 months (range 3–35) in the pregnant and non-pregnant groups, respectively. On multivariate analysis, age, body mass index, treatment duration, medroxyprogesterone dose, and number of dilatation and curettage biopsies were not significantly associated with pregnancy failure, but the association with grade (OR 6.2, 95% CI 1.0 to 38.9; P<0.05) was statistically significant. The median disease-free survival duration was 26 months (range 20–38) and 12 months (range 4–48) in the pregnant and non-pregnant groups, respectively (P<0.05, log-rank test).

Conclusions A lower grade might be a positive factor for future pregnancy. Moreover, successful pregnancy might be a factor in preventing recurrence.

  • endometrial cancer
  • fertility
  • medroxyprogesterone 17-acetate
  • pregnancy outcomes
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Footnotes

  • Contributors Both co-corresponding authors contributed equally to this paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Institutional review board approval for this study (KUH1040065).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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