Pregnancy and oncologic outcomes after fertility-sparing management for early stage endometrioid endometrial cancer

Abstract

ObjectiveHormonal management is an alternative treatment for preserving fertility in patients with presumed early stage endometrioid endometrial cancer. This study aimed to define the pregnancy and oncologic outcomes and factors of successful conception after hormone therapy for endometrioid endometrial cancer.MethodsWe retrospectively analyzed patients presumed to have stage IA, grade 1–2 endometrioid endometrial cancer who underwent fertility-sparing treatment. Concurrent medroxyprogesterone and levonorgestrel-release intra-uterine devices were used for treatment. The pregnancy outcomes and oncologic outcomes were compared between the pregnant and non-pregnant groups.ResultsSeventy-one patients presumed to have stage IA, grade 1–2 endometrioid endometrial cancer had complete remission, and 49 of them tried to conceive. Twenty-two (44.9%) patients became pregnant; the total number of pregnancies was 30. These pregnancies resulted in seven abortions (23.3%), one pre-term birth (3.3%), and 20 full-term births (66.6%). The total live birth rate was 66.6 % (20/30). The median duration of hormonal treatment was 11.9 months (range 4–49) and 12.0 months (range 3–35) in the pregnant and non-pregnant groups, respectively. On multivariate analysis, age, body mass index, treatment duration, medroxyprogesterone dose, and number of dilatation and curettage biopsies were not significantly associated with pregnancy failure, but the association with grade (OR 6.2, 95% CI 1.0 to 38.9; P<0.05) was statistically significant. The median disease-free survival duration was 26 months (range 20–38) and 12 months (range 4–48) in the pregnant and non-pregnant groups, respectively (P<0.05, log-rank test).ConclusionsA lower grade might be a positive factor for future pregnancy. Moreover, successful pregnancy might be a factor in preventing recurrence.

Fertility-sparing treatment in women with endometrial cancer

“…Candidates should have a minimal risk of metastatic disease or local invasion and therefore a higher chance of regression; thus, the ideal candidates for fertility-sparing treatment have been suggested to be young women with grade 1 endometrioid adenocarcinoma confined to the endometrium. Few studies [4,[18][19][20] have reported the outcomes of fertility-sparing treatment for patients with more advanced disease. Park et al [18] reported the outcomes of fertility-sparing treatment for grade 2-3 EC with or without superficial myometrial invasion.…”

“…The rates of complete response (CR) to fertility-sparing treatment were 76.5%, 73.9%, and 87.5% for patients with stage IA (without myometrial invasion) grade 2-3 disease, patients with stage IA (with superficial myometrial invasion) grade 1 disease, and patients with stage IA (with superficial myometrial invasion) grade 2-3 disease, respectively [18]. Chae et al [4] reported pregnancy outcomes of fertility-sparing treatments and demonstrated that a higher grade was also closely associated with pregnancy failure. Although a few reports have indicated that fertility-sparing treatment can be safe and effective for EC patients with grade 2-3 disease or superficial myometrial invasion [4,[18][19][20], expansion of the criteria for target patients is not yet recommended due to the paucity of high-quality evidence.…”

“…Chae et al [4] reported pregnancy outcomes of fertility-sparing treatments and demonstrated that a higher grade was also closely associated with pregnancy failure. Although a few reports have indicated that fertility-sparing treatment can be safe and effective for EC patients with grade 2-3 disease or superficial myometrial invasion [4,[18][19][20], expansion of the criteria for target patients is not yet recommended due to the paucity of high-quality evidence.…”

“…Although typically diagnosed in postmenopausal individuals, 3%-14% of EC cases occur in those younger than 40 years. The overall incidence of EC has increased, most rapidly in the under 40 age group, the members of whom frequently are nulliparous and strongly desire to keep their fertility [1][2][3][4][5]. consensus or guidelines regarding target patients, treatment methods, and surveillance [17].…”

Brazilian Society of Surgical Oncology guidelines for surgical treatment of endometrial cancer in regions with limited resources

“…12 Although less useful in assessing uterine abnormalities than MRI and US, CT scan has better multiplanar spatial resolution and is useful for visualizing large lymph nodes and pulmonary metastases in the entire abdominopelvic cavity. 11 Three retrospective series [14][15][16] have shown that follow-up with uterine curettage every 3 months is safe.…”