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  • PR047/#454  Oncological outcomes in patients undergoing fertility-sparing treatment of atypical hyperplasia and grade 1 endometrial cancer using progestin therapy: results of a novel, specialized oncofertility program

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Poster Rounds 10: Endometrial Cancer Outcome Prediction
AS04. Endometrial/Uterine corpus cancers
PR047/#454  Oncological outcomes in patients undergoing fertility-sparing treatment of atypical hyperplasia and grade 1 endometrial cancer using progestin therapy: results of a novel, specialized oncofertility program
  1. Oleksandra Dzyubak1,2,
  2. Rachel Kim1,2,
  3. Karen Glass2,
  4. Megan Watts3,
  5. Oishika Tarafdar4,
  6. Andrea Simpson2,
  7. Manjula Maganti5,
  8. Shima Deljoomanesh1,
  9. Stephane Laframboise1,2 and
  10. Sarah Ferguson1,2
  1. 1Princess Margaret Cancer Center/University Health Network, Gynecologic Oncology, Toronto, Canada
  2. 2University of Toronto, Obstetrics and Gynaecology, Toronto, Canada
  3. 3Princess Margaret Cancer Centre, Gynecologic Oncology, Toronto, Canada
  4. 4Temerty Faculty of Medicine, Toronto, Canada
  5. 5Princess Margaret Cancer Center/University Health Network, Biostatistics, Toronto, Canada

Abstract

Introduction This study describes the oncological outcomes of patients with atypical hyperplasia (AH) or low-grade endometrial cancer (EC) desiring fertility preservation, enrolled in a specialized oncofertility program.

Methods Patients referred between 2019–2023 were reviewed. This novel program provides integrated oncologic and reproductive endocrinology and infertility care, following standardized treatment pathways. Enrollment criteria include: AH/EC grade 1 histology, no myometrial invasion or extra-uterine disease and desire to preserve fertility. Progestin IUD was the preferred treatment due to tolerance and compliance. Kaplan-Meier and Cox regression models were used to estimate the event rates and outcome predictors.

Results Of 180 patients, 101 (56%) had AH and 79 (44%) had EC. Median age was 35.4 years (22.3–45.1) and median BMI was 32.7 kg/m2 (17.6–64.1). Median follow up was 20.7 (0.49–134) months. In 149 patients on progestin treatment, the complete response (CR) rate was 78% (AH 82%; EC 72%). The CR probability for the whole cohort at 24 months was 82.4%. AH group had a significantly higher CR probability than EC (87.8% vs 73.6%, p= 0.011, figure 1). The median time to CR was 10.3 months. On multivariate analysis, higher BMI was associated with lower likelihood of CR (HR 0.97, p=0.004). Despite routine endometrial protection with progestin, recurrence probability at 24 months was 32%, with no difference between AH and EC (33% vs 31%, p=0.62, figure 2). There was no extrauterine recurrence or death.

Conclusion/Implications Patients in a specialized oncofertility program had high rates of CR that continued up to 24 months suggesting that longer periods of treatment are feasible.

Abstract PR047/#454 Figure 1
Abstract PR047/#454 Figure 1

Probability of complete response (CR) by pathology (n=149)

Abstract PR047/#454 Figure 2
Abstract PR047/#454 Figure 2

Probability of the recurrence free rate by pathology (n=116)

https://doi.org/10.1136/ijgc-2024-IGCS.89

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