癌症与生殖结局：促性腺激素释放激素激动剂联合芳香化酶抑制剂或左炔诺孕酮宫内缓释系统用于治疗子宫内膜癌或不典型子宫内膜增生患者的疗效比较。
Oncological and reproductive outcomes for gonadotropin-releasing hormone agonist combined with aromatase inhibitors or levonorgestrel-releasing intra-uterine system in women with endometrial cancer or atypical endometrial hyperplasia.
机构信息
Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric and Gynecologic Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
出版信息
Int J Gynecol Cancer. 2022 Dec 5;32(12):1561-1567. doi: 10.1136/ijgc-2022-003882.
OBJECTIVE
To evaluate the efficacy and safety of gonadotropin-releasing hormone agonist (GnRHa) combined with a levonorgestrel-releasing intrauterine device (LNG-IUD) or aromatase inhibitor (letrozole) in women with endometrial carcinoma or atypical endometrial hyperplasia who wished to preserve fertility.
METHODS
Patients at the Department of Obstetrics and Gynecology, Peking Union Medical College Hospital between January 2013 and December 2020 were retrospectively reviewed. A total of 179 patients who were unsuitable to undergo treatment with high-dose oral progestin, including those with progestin allergies, body mass index ≥30 kg/m, liver and/or renal dysfunction, hypercoagulable state, and thrombosis were included. Patient data were retrieved from medical records and a prospectively maintained database that represented the standard protocol was followed for all patients. Clinical characteristics, treatment outcomes, adverse events, and reproductive outcomes were collected and analyzed. Logistic regression models were constructed to determine the associations between complete remission, recurrence, and fertility.
RESULTS
Overall, 169 patients (94.4%) achieved complete remission; 58 (96.7%) had atypical endometrial hyperplasia and 111 (93.3%) had endometrial carcinoma. The complete remission rates for the GnRHa plus LNG-IUD and GnRHa plus letrozole groups were 93.5% and 95.8%, respectively. The median time to complete remission was 6 (range 3-18) months: 4 (range 3-10) months for atypical endometrial hyperplasia and 8 (range 3-18) months for endometrial carcinoma. After a median follow-up of 27.5 (range 3-92) months, 41 (24.3%) women developed recurrence, with a median recurrence time of 17 (range 6-77) months. Of the patients with complete remission, 134 patients desired to conceive and 42 (32.3%) became pregnant, 24 (17.9%) were successfully delivered, 5 (3.7%) were still pregnant, while 13 miscarried.
CONCLUSION
GnRHa combined treatment provides favorable oncological and reproductive outcomes. Larger multi-institutional studies are required to confirm these preliminary findings.
目的
评估促性腺激素释放激素激动剂（GnRHa）联合左炔诺孕酮宫内缓释系统（LNG-IUD）或芳香化酶抑制剂（来曲唑）治疗希望保留生育能力的子宫内膜癌或不典型子宫内膜增生患者的疗效和安全性。
方法
回顾性分析 2013 年 1 月至 2020 年 12 月北京协和医院妇产科患者的临床资料。共纳入 179 例不适合接受大剂量口服孕激素治疗的患者，包括孕激素过敏、体质量指数≥30kg/m2、肝肾功能不全、高凝状态和血栓形成等。从病历和前瞻性维护的数据库中检索患者数据，所有患者均遵循标准方案。收集并分析临床特征、治疗结局、不良事件和生育结局。构建逻辑回归模型以确定完全缓解、复发和生育之间的关联。
结果
总体而言，169 例（94.4%）患者达到完全缓解；58 例（96.7%）为不典型子宫内膜增生，111 例（93.3%）为子宫内膜癌。GnRHa 联合 LNG-IUD 组和 GnRHa 联合来曲唑组的完全缓解率分别为 93.5%和 95.8%。完全缓解时间的中位数为 6（范围 3-18）个月：不典型子宫内膜增生为 4（范围 3-10）个月，子宫内膜癌为 8（范围 3-18）个月。中位随访 27.5（范围 3-92）个月后，41 例（24.3%）患者复发，复发时间的中位数为 17（范围 6-77）个月。在完全缓解的患者中，134 例有生育要求，42 例（32.3%）妊娠，24 例（17.9%）成功分娩，5 例（3.7%）仍在妊娠，13 例流产。
结论
GnRHa 联合治疗可获得良好的肿瘤学和生殖结局。需要更大规模的多机构研究来证实这些初步发现。
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