Pregnancy outcomes after fertility-sparing management in young women with early endometrial cancer.

Abstract

OBJECTIVE:

To analyze pregnancy outcomes in young women with stage IA, grade 1 endometrioid adenocarcinoma of the uterus after successful fertility-sparing management using progestin.

METHODS:

We reviewed the medical records of 141 women with stage IA, grade 1 endometrioid adenocarcinoma of the uterus who had complete remission after progestin treatment. Statistical analysis was performed using Student's t test or Mann-Whitney U test for continuous variables, using χ or Fisher's exact test for categorical variables, and using log-rank test for survival comparison.

RESULTS:

Fifty-four (38.3%) women in the study cohort had a history of infertility. Seventy (49.6%) of the 141 patients tried to conceive with 44 (62.9%) receiving fertility drugs. The median interval to attempted pregnancy after treatment was 5 months (range 1-31 months). The median age at the time of the pregnancy trial was 32.4 years (range 23-40 years). Fifty-one (73%) of 70 women who tried to conceive were successful and 46 (66%) gave birth to 58 live neonates. The spontaneous abortion rate, ectopic pregnancy rate, and preterm delivery rates in our cohort were 24%, 2.8%, and 11.5%, respectively. The 5-year disease-free survival was similar between patients who received fertility drugs (n=44) or who did not (n=97) (73% compared with 62%, P=.335), and this rate was significantly higher in patients who achieved at least one pregnancy (n=51) than those who did not (n=90) (76% compared with 62%, P=.028).

CONCLUSIONS:

Although the proportion of patients with a history of subfertility or infertility was high in our cohort, the pregnancy outcomes were very promising using assisted reproductive technology. The use of fertility drugs was not associated with a higher incidence of cancer recurrence after successful fertility-sparing management in this study population.

LEVEL OF EVIDENCE:

II.

• Authors: Jeong-Yeol Park, Seok Ju Seong, Tae-Jin Kim, Jae Weon Kim, Seok Mo Kim, Duk-Soo Bae, Joo-Hyun Nam
• Journal: Obstetrics and gynecology (Obstet Gynecol) Vol. 121 Issue 1 Pg. 136-42 (Jan 2013) ISSN: 1873-233X [Electronic] United States
• PMID: 23262938 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antineoplastic Agents, Hormonal
• Fertility Agents
• Medroxyprogesterone Acetate
• Megestrol Acetate

Topics

• Abortion, Spontaneous (epidemiology)
• Adult
• Antineoplastic Agents, Hormonal (therapeutic use)
• Carcinoma, Endometrioid (drug therapy)
• Disease-Free Survival
• Endometrial Neoplasms (drug therapy)
• Female
• Fertility Agents (therapeutic use)
• Humans
• Infant, Newborn
• Infertility, Female (drug therapy)
• Medroxyprogesterone Acetate (therapeutic use)
• Megestrol Acetate (therapeutic use)
• Neoplasm Grading
• Neoplasm Staging
• Pregnancy
• Pregnancy Complications, Neoplastic (drug therapy)
• Pregnancy Outcome
• Pregnancy Rate
• Pregnancy, Ectopic (epidemiology)
• Premature Birth (epidemiology)
• Retrospective Studies
• Treatment Outcome
• Young Adult