关键词: 子宫内膜复杂增生, 子宫内膜癌, 保留生育功能的治疗, 孕激素治疗

Abstract: Objective To investigate the oncologic and reproductive outcomes after progestin treatment of complex endometrial hyperplasia (CEH) and grade 1 endometrial carcinoma (EC). Methods In a retrospective study, data were obtained for patients with CEH or grade 1 EC at presumed stage IA (without myometrial invasion) who wished to preserve fertility and were treated at the Peking Union Medical College Hospital, China, between January 1, 2000, and December 31, 2011. Patients had received oral medroxyprogesterone acetate (250–500?mg/day) or megestrol acetate (160–480?mg/day) for at least 6?months. Results Among 53 included patients, median age was 32 years(range 20–42?years). 41(75%) achieved complete response after a median period of 6 (3–24) months. Complete response was less frequent among obese than nonobese patients (4/12 [33%] vs 37/43 [86%]; P=0.001). Disease recurrence was recorded in 10 (26%) patients with complete response; the 5-year recurrence-free survival rate was 71%. Among the 33 patients who retained a desire to conceive, 17 (52%) became pregnant. Conclusion Fertility-sparing management with oral progestin is effective. Obesity is associated with a lower probability of long-term success.

Key words: Complex endometrial hyperplasia, Endometrial carcinoma, Fertility-sparing treatment, Progestin therapy