Analysis of factors affecting the success of fertility preservation for early-stage endometrial carcinoma and atypical endometrial hyperplasia: a retrospective study from a single center

Background: To investigate the outcome of fertility preservation therapy in patients with early well-differentiated endometrial carcinoma (EC) and atypical endometrial hyperplasia (AEH). Methods: A retrospective analysis of the clinicopathological data and treatment outcomes of 31 cases of endometrial carcinoma (EC) and 93 cases of endometrial atypical hyperplasia (AEH) who were admitted to our hospital for fertility preservation from January 2013 to December 2020 was conducted. Univariate and multivariate analyses were used to evaluate the risk factors for complete response and recurrence. Statistical analysis was used to assess the effectiveness of both single drug and multi-drug combinations. Results: The total complete response (CR) rate was 92%. There was no significant difference between the two groups. The study revealed that patients with endometrial cancer who received high-efficiency progestin-based combination regimens experienced a significant reduction in treatment time (5.9 ± 3.3 vs. 3.1 ± 0.4 months, p = 0.001). The total pregnancy rate was 35%. Multivariate analysis showed irregular menstruation (odds ratio (OR) = 0.329, 95% confidence interval (CI) = 0.126–0.862, p = 0.024) and treatment time to complete response months (>6 months, OR = 0.254, 95% CI = 0.087–0.740, p = 0.012) were independent factors to reduce pregnancy rate. Furthermore, our findings indicated that there were no significant differences in complete response rate, recurrence rate and pregnancy rate between patients with grade-2 (G2) and patients with grade-1 (G1) EC (p ≥ 0.05). Conclusions: Fertility preservation is safe and feasible for grade-2 endometrial carcinoma whereas Progestin-based combination therapy seems more effective than monotherapy for the treatment of fertility preservation.

Endometrial cancer; Atypical endometrial hyperplasia; Female infertility; Fertility preservation

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