Effect and Management of Excess Weight in the Context of Fertility-Sparing Treatments in Patients With Atypical Endometrial Hyperplasia and Endometrial Cancer: Eight-Year Experience of 227 Cases
ObjectiveTo investigate the oncologic and reproductive outcomes of fertility-sparing treatments (FSTs) in atypical endometrial hyperplasia (AEH) and endometrial cancer (EC) patients with excess weight (EW).MethodsThis retrospective study comprised patients with AEH or EC who achieved a complete resp...
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Frontiers Media S.A.
2021
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oai:doaj.org-article:9e0d81efc921486098f71662302fa1c52021-11-05T11:46:35ZEffect and Management of Excess Weight in the Context of Fertility-Sparing Treatments in Patients With Atypical Endometrial Hyperplasia and Endometrial Cancer: Eight-Year Experience of 227 Cases2234-943X10.3389/fonc.2021.749881https://doaj.org/article/9e0d81efc921486098f71662302fa1c52021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fonc.2021.749881/fullhttps://doaj.org/toc/2234-943XObjectiveTo investigate the oncologic and reproductive outcomes of fertility-sparing treatments (FSTs) in atypical endometrial hyperplasia (AEH) and endometrial cancer (EC) patients with excess weight (EW).MethodsThis retrospective study comprised patients with AEH or EC who achieved a complete response (CR) after FST from 2010 to 2018. The clinical characteristics, oncological and reproductive outcomes were compared between the excess weight (EW) group (body mass index (BMI)≥25 kg/m2) and normal weight (NW) group (BMI<25 kg/m2). The risk factors associated with recurrence and unsuccessful pregnancy in patients with EW were analyzed.ResultsOverall, 227 patients were enrolled, including 139 (61.2%) in EW group and 88 (38.8%) in NW group. In patients with EW, the pregnancy rate, the live birth rate and the relapse rate were 29.8%, 23.4%, and 30.9%, respectively. In patients with NW, these rates were 61.1%, 47.2%, and 31.8%, respectively. No significant differences were observed in the time to remission (P=0.865) and disease-free survival (DFS) (P=0.750). Patients in NW group achieved a better pregnancy rate than patients in the EW group (P=0.034). The patients with EW using ovulation induction to increase fertility tended to have a shorter time to pregnancy (P=0.042). However, no significant risk factors associated with unsuccessful pregnancy were identified after the multivariate analysis. In terms of DFS, the combination of gonadotropin-releasing hormone agonist (GnRH-a) and LNG-IUD was better for patients with EW than GnRH-a or oral progestin therapy alone (P=0.044, adjusted hazard ratio (HR)=0.432, 95% confidence interval (CI): 0.152-1.229), especially for patients with EW diagnosed with EC (P=0.032).ConclusionFSTs for overweight and obese patients should be more individualized. GnRH-a and/or LNG-IUD may be options prior to FSTs in patients with EW. Further prospective studies are needed.Ying ShanYing ShanMeng QinMeng QinJie YinJie YinYan CaiYan CaiYan LiYan LiYu GuYu GuWei WangWei WangYong-xue WangYong-xue WangJia-yu ChenJia-yu ChenYing JinYing JinLing-ya PanLing-ya PanFrontiers Media S.A.articlefertility-sparing treatmentsatypical endometrial hyperplasia (AEH)endometrial cancer (EC)excess weightlevonorgestrel intrauterine devicesgonadotropin-releasing hormone agonist (GnRH- a)Neoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENFrontiers in Oncology, Vol 11 (2021) |
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| collection |
DOAJ |
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EN |
| topic |
fertility-sparing treatments atypical endometrial hyperplasia (AEH) endometrial cancer (EC) excess weight levonorgestrel intrauterine devices gonadotropin-releasing hormone agonist (GnRH- a) Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 |
| spellingShingle |
fertility-sparing treatments atypical endometrial hyperplasia (AEH) endometrial cancer (EC) excess weight levonorgestrel intrauterine devices gonadotropin-releasing hormone agonist (GnRH- a) Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Ying Shan Ying Shan Meng Qin Meng Qin Jie Yin Jie Yin Yan Cai Yan Cai Yan Li Yan Li Yu Gu Yu Gu Wei Wang Wei Wang Yong-xue Wang Yong-xue Wang Jia-yu Chen Jia-yu Chen Ying Jin Ying Jin Ling-ya Pan Ling-ya Pan Effect and Management of Excess Weight in the Context of Fertility-Sparing Treatments in Patients With Atypical Endometrial Hyperplasia and Endometrial Cancer: Eight-Year Experience of 227 Cases |
| description |
ObjectiveTo investigate the oncologic and reproductive outcomes of fertility-sparing treatments (FSTs) in atypical endometrial hyperplasia (AEH) and endometrial cancer (EC) patients with excess weight (EW).MethodsThis retrospective study comprised patients with AEH or EC who achieved a complete response (CR) after FST from 2010 to 2018. The clinical characteristics, oncological and reproductive outcomes were compared between the excess weight (EW) group (body mass index (BMI)≥25 kg/m2) and normal weight (NW) group (BMI<25 kg/m2). The risk factors associated with recurrence and unsuccessful pregnancy in patients with EW were analyzed.ResultsOverall, 227 patients were enrolled, including 139 (61.2%) in EW group and 88 (38.8%) in NW group. In patients with EW, the pregnancy rate, the live birth rate and the relapse rate were 29.8%, 23.4%, and 30.9%, respectively. In patients with NW, these rates were 61.1%, 47.2%, and 31.8%, respectively. No significant differences were observed in the time to remission (P=0.865) and disease-free survival (DFS) (P=0.750). Patients in NW group achieved a better pregnancy rate than patients in the EW group (P=0.034). The patients with EW using ovulation induction to increase fertility tended to have a shorter time to pregnancy (P=0.042). However, no significant risk factors associated with unsuccessful pregnancy were identified after the multivariate analysis. In terms of DFS, the combination of gonadotropin-releasing hormone agonist (GnRH-a) and LNG-IUD was better for patients with EW than GnRH-a or oral progestin therapy alone (P=0.044, adjusted hazard ratio (HR)=0.432, 95% confidence interval (CI): 0.152-1.229), especially for patients with EW diagnosed with EC (P=0.032).ConclusionFSTs for overweight and obese patients should be more individualized. GnRH-a and/or LNG-IUD may be options prior to FSTs in patients with EW. Further prospective studies are needed. |
| format |
article |
| author |
Ying Shan Ying Shan Meng Qin Meng Qin Jie Yin Jie Yin Yan Cai Yan Cai Yan Li Yan Li Yu Gu Yu Gu Wei Wang Wei Wang Yong-xue Wang Yong-xue Wang Jia-yu Chen Jia-yu Chen Ying Jin Ying Jin Ling-ya Pan Ling-ya Pan |
| author_facet |
Ying Shan Ying Shan Meng Qin Meng Qin Jie Yin Jie Yin Yan Cai Yan Cai Yan Li Yan Li Yu Gu Yu Gu Wei Wang Wei Wang Yong-xue Wang Yong-xue Wang Jia-yu Chen Jia-yu Chen Ying Jin Ying Jin Ling-ya Pan Ling-ya Pan |
| author_sort |
Ying Shan |
| title |
Effect and Management of Excess Weight in the Context of Fertility-Sparing Treatments in Patients With Atypical Endometrial Hyperplasia and Endometrial Cancer: Eight-Year Experience of 227 Cases |
| title_short |
Effect and Management of Excess Weight in the Context of Fertility-Sparing Treatments in Patients With Atypical Endometrial Hyperplasia and Endometrial Cancer: Eight-Year Experience of 227 Cases |
| title_full |
Effect and Management of Excess Weight in the Context of Fertility-Sparing Treatments in Patients With Atypical Endometrial Hyperplasia and Endometrial Cancer: Eight-Year Experience of 227 Cases |
| title_fullStr |
Effect and Management of Excess Weight in the Context of Fertility-Sparing Treatments in Patients With Atypical Endometrial Hyperplasia and Endometrial Cancer: Eight-Year Experience of 227 Cases |
| title_full_unstemmed |
Effect and Management of Excess Weight in the Context of Fertility-Sparing Treatments in Patients With Atypical Endometrial Hyperplasia and Endometrial Cancer: Eight-Year Experience of 227 Cases |
| title_sort |
effect and management of excess weight in the context of fertility-sparing treatments in patients with atypical endometrial hyperplasia and endometrial cancer: eight-year experience of 227 cases |
| publisher |
Frontiers Media S.A. |
| publishDate |
2021 |
| url |
https://doaj.org/article/9e0d81efc921486098f71662302fa1c5 |
| work_keys_str_mv |
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