National patterns of care and fertility outcomes for reproductive-aged women with endometrial cancer or atypical hyperplasia

Abstract

BACKGROUND: Although it is uncommon, the incidence of endometrial cancer and atypical hyperplasia among reproductive-aged women is increasing. The fertility outcomes in this population are not well described. OBJECTIVE: We aim to describe the patterns of care and fertility outcomes of reproductive-aged women with endometrial cancer or atypical hyperplasia. MATERIALS AND METHODS: A cohort of women aged 45 years with endometrial cancer or atypical hyperplasia diagnosed in 2000 to 2014 were identified in Truven Marketscan, an insurance claims database of commercially insured patients in the United States. Treatment information, including use of progestin therapy, hysterectomy, and assisted fertility services, was identified and collected using a combination of Common Procedural Terminology codes, International Statistical Classification of Diseases and Related Health Problems codes, and National Drug Codes. Pregnancy events were identified from claims data using a similar technique. Patients were categorized as receiving progestin therapy alone, progestin therapy followed by hysterectomy, or standard surgical management with hysterectomy alone. Multivariable logistic regression was performed to assess factors associated with receiving fertility-sparing treatment. RESULTS: A total of 4007 reproductive-aged patients diagnosed with endometrial cancer or atypical hyperplasia were identified. The majority of these patients (n ¼ 3189; 79.6%) received standard surgical management. Of the 818 patients treated initially with progestins, 397 (48.5%) subsequently underwent hysterectomy, whereas 421 (51.5%) did not. Patients treated with progestin therapy had a lower median age than those who received standard surgical management (median age, 36 vs 41 years; P < .001). The proportion of patients receiving progestin therapy increased significantly over the observation period, with 24.9% treated at Harrison et al. Fertility conservation and pregnancy outcomes in young women with endometrial cancer or hyperplasia. Am J Obstet Gynecol 2019.

Conservative Management of Endometrial Carcinoma and Precursor Lesions Preceding IVF Treatment: A Case Series

“…In contrast, reproductive outcomes display more discouraging results in a recent large cohort study conducted in 2019 which included 421 patients diagnosed with endometrial cancer and complex endometrial hyperplasia with atypia who received fertility-sparing treatment [14]. The resulting live birth rate was only 11.6% [14]. Although only 15.5% of the cases were treated with assisted fertility services, 50% of the total live birth rate resulted from these cases [14].…”

“…The resulting live birth rate was only 11.6% [14]. Although only 15.5% of the cases were treated with assisted fertility services, 50% of the total live birth rate resulted from these cases [14]. They proposed that women affected by endometrial carcinoma and/or its precursors have inherent risks for lower reproductive potential as a result of their disease [14].…”

“…Although only 15.5% of the cases were treated with assisted fertility services, 50% of the total live birth rate resulted from these cases [14]. They proposed that women affected by endometrial carcinoma and/or its precursors have inherent risks for lower reproductive potential as a result of their disease [14]. However, the purpose of these studies was not to specifically evaluate patient outcomes in the setting of infertility.…”

Fertility-sparing Surgery for Patients with Cervical, Endometrial, and Ovarian Cancers

“…57,77 For women who conceive after progestin therapy, 54% of those who became pregnant required ART; the median time between diagnosis and live birth was 2.07 years. 78 Age, BMI, and endometrial receptivity affect ART success. In addition, progestin therapy can result in a thinner endometrial lining and increase risk of intrauterine synechiae which can negatively impact implantation.…”

Fertility-Sparing Methods in Adolescents Affected by Endometrial Cancer: A Comprehensive Review

“…Generally, EC is diagnosed in post- and perimenopausal women; however, recent reports state that approximately 7% of cases are diagnosed in young women aged 20 to 44 years [ 3 ]. It is expected that the incidence of EC in this age group will continue to be on the increase as a reflection of rising trends observed in the prevalence of EC risk factors such as obesity and diabetes mellitus [ 4 , 5 ]. It is difficult to provide precise estimations of the incidence of EC in the adolescent population because its occurrence in very young patients is exceedingly rare.…”