摘要
Abstract
Objective:To investigate the factors associated with disease recurrence and pregnancy outcomes in patients with early-stage endometrial carcinoma(EC)and atypical endometrial hyperplasia(AH)who achieved complete remission(CR)after fertility-sparing treatment.Methods:A retrospective analysis was conducted on clinical data from 108 patients diagnosed with early-stage EC or AH who achieved CR after fertility-sparing treat-ment at the Department of Gynecology,The Third Xiangya Hospital of Central South University,between January 1,2012,and December 31,2024.Logistic regression analysis was performed to identify independent factors influen-cing recurrence,pregnancy,and live birth.The recurrence and pregnancy outcomes were compared among pa-tients receiving different treatment modalities,including oral high-efficiency progestogens(progestogen group),levonorgestrel-releasing intrauterine system(LNG-IUS group),and combined treatment of oral high-efficiency pro-gestogens plus intrauterine LNG-IUS placement(combination therapy group).Results:①Higher Body mass in-dex(BMI)(OR 1.22,95％CI 1.05-1.41),concurrent polycystic ovary syndrome(PCOS)(OR 3.30,95％CI 1.24-8.81),and combined therapy(OR 0.12,95％CI 0.03-0.42)were independent factors associated with re-currence of early-stage EC and AH after fertility-sparing treatment(P<0.05).In patients who experienced recur-rence,the time to achieve CR was negatively correlated with the time to recurrence(r=-0.336,P<0.05).②As-sisted reproductive technology(ART)-mediated pregnancy(OR 2.49,95％CI 1.05-5.86)and combined therapy(OR 3.07,95％CI 1.09-8.67)were independent factors of pregnancy(P<0.05).③Use of ART(OR 15.55,95％CI 1.62-149.50)and combination therapy(OR 23.15,95％CI 2.05-260.90)were independent factors of live birth(P<0.05).④The recurrence rate in the combination therapy group(12.20％)was lower than that in the pro-gestogen group(44.44％)and the LNG-IUS group(54.84％),while the live birth rate in the combination therapy group(58.54％)was higher than that in the progestogen group(17.65％)and the LNG-IUS group(12.90％).All these differences were statistically significant(P<0.05).Conclusions:Higher BMI and concurrent PCOS are high-risk factors for recurrence in patients with early-stage EC and AH after fertility-sparing treatment.A shorter time to achieve CR correlates with a delayed onset of recurrence.The combination therapy demonstrates signifi-cant advantages in reducing recurrence,while both combination therapy and ART improve pregnancy and live birth.关键词
早期子宫内膜癌/子宫内膜不典型增生/保留生育力治疗/复发/妊娠结局/治疗方式Key words
Early-stage endometrial cancer/Atypical endometrial hyperplasia/Fertility-sparing treatment/Re-currence/Pregnancy outcome/Treatment modality分类
医药卫生
