Journal of Shandong University (Health Sciences) ›› 2018, Vol. 56 ›› Issue (5): 23-29.doi: 10.6040/j.issn.1671-7554.0.2018.229

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Diagnosis and management in patients with recurrent stage I endometrial cancer after primary fertility-preserving treatment

YU Mei, YANG Jiaxin, CAO Dongyan, WANG Yao, SHEN Keng   

  1. Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science &
    Peking Union Medical College, Beijing 100730, China
  • Received:2018-02-14 Published:2022-09-27

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Abstract: Objective To evaluate the efficacy and prognosis of secondary treatment on patients with recurrent endometrial cancer(EC)after complete remission(CR)for primary fertility-preserving therapy. Methods Thirty-six cases with recurrent EC after CR for primary fertility-preserving therapy from January 2004 to September 2017 at Peking Union Medical College Hospital were retrospectively analyzed. Twenty-five patients received the second course of fertility-preserving treatment and 11 patients received hysterectomy. The clinical efficacy and prognosis of the retreatment were also analyzed. Results Of the 36 recurrent patients with a median disease free interval period of 17 months(ranged 6 to 55 months), 22 were pathologically diagnosed as EC, and 14 were pathologically diagnosed as atypical hyperplasia(AH)or endometrial intraepithelial neoplasia(EIN). Twenty-five patients met the criteria of fertility-preserving therapy and repeated hormonal therapy, and 21 patients were evaluable for efficacy, among whom, 16 patients achieved CR(16/21, 76.2%)with the lower CR rate than that of primary fertility-preserving treatment(93.6%), P= 山 东 大 学 学 报 (医 学 版)56卷5期 -俞梅,等.早期子宫内膜癌保留生育功能治疗后复发的诊治 \=-0.016. According to the pathologic diagnosis of recurrence, the CR rate in AH/EIN patients was higher than that in EC patients while without a statistical difference(90.9% vs 60.0%, P=0.149). Among 16 patients achieved CR, 2 got pregnant and delivered successfully, while 2 relapsed again. Five cases failed to retreatment of fertility-preserving therapy then took the surgery; two of them were of stage ⅢA and three of stage ⅠA; three of them needed adjuvant radiotherapy +/- chemotherapy postoperatively, and no recurrence was observed during the follow-up. Eleven patients received surgery, eight of whom were treated in our hospital with one of stage ⅢC2, five of stage ⅠA, two diagnosed as EIN or AH1-2, and no recurrence was observed during the follow-up. Other three patients were lost to follow-up. Conclusion For patients with recurrent EC after primary fertility-preserving treatment, CR rate of retreatment was lower than that of primary treatment, while still attain a promising response and have possibilities of successful pregnancies.

Key words: Endometrial cancer, Atypical endometrial hyperplasia, Endometrial intraepithelial neoplasia, Recurrence, Fertility-preserving therapy

CLC Number: 

  • R711.74
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