Characteristics of progestin-insensitive early stage endometrial cancer and atypical hyperplasia patients receiving second-line fertility-sparing treatment

Shuang Zhou, Zhiying Xu, Bingyi Yang, Jun Guan, Weiwei Shan, Yue Shi, Xiaojun Chen, Shuang Zhou, Zhiying Xu, Bingyi Yang, Jun Guan, Weiwei Shan, Yue Shi, Xiaojun Chen

Abstract

Objective: This study investigated the characteristics of progestin-insensitive endometrioid endometrial cancer (EEC) and atypical endometrial hyperplasia (AEH) patients receiving fertility-sparing treatments and assessed the therapeutic effects of second-line fertility-preserving treatments.

Methods: Three hundred and thirty-eight patients with EEC (n=75) or AEH (n=263) receiving fertility-preserving treatment were retrospectively analyzed. 'Progestin-insensitive' was defined as meeting one of the following criteria: 1) presented with progressed disease at any time during conservative treatment, 2) remained with stable disease after 7 months of treatment, and/or 3) did not achieve complete response (CR) after 10 months of treatment. Clinical characteristics and treatment results of progestin-insensitive patients receiving second-line treatment and those of progestin-sensitive patients were compared.

Results: Eight-two patients (59 AEH and 23 EEC) were defined as progestin-insensitive and 256 as progestin-sensitive. In multivariate analysis, body mass index ≥28.0 kg/m² (odds ratio [OR]=1.898) and lesion size >2 cm (OR=2.077) were independent predictors of progestin-insensitive status. Compared to AEH patients, progestin-insensitive EEC patients had poorer second-line treatment responses (28-week cumulative CR rate after changing second-line treatment, 56.3% vs. 85.4%, p=0.011). No statistical difference was found in CR rate among different second-line treatments.

Conclusion: Obesity and larger lesion size were independent risk factors associated with progestin-insensitive status. In progestin-insensitive patients receiving second-line treatment, EEC patients had lower CR rate comparing with AEH patients. Further study with larger sample size is needed to evaluate efficacy of different second-line treatments for progestin insensitive patients.

Keywords: Conservative Treatment; Endometrial Hyperplasia; Endometrial Neoplasms.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Copyright © 2021. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology, and Japan Society of Gynecologic Oncology.

Figures

Fig. 1. Possible risk factors related to…
Fig. 1. Possible risk factors related to progestin-insensitive status (versus progestin-sensitive cases).
Univariate and multivariate logistic regression models were used to identify risk factors associated with progestin-insensitive status in all patients or AEH patients (A, B). *Missing data for 51 cases for HE-4 and 55 for lesion size. AEH, atypical endometrial hyperplasia; CI, confidence interval; EEC, endometrioid endometrial carcinoma; HE-4, human epididymis protein 4; HOMA-IR, homeostasis model assessment-insulin resistance.
Fig. 2. The 28-week CR rate in…
Fig. 2. The 28-week CR rate in progestin-insensitive patients with different second-line options (A) and the 28-week CR rate after initiating second-line treatment (B) of AEH and EEC patients.
AEH, atypical endometrial hyperplasia; CI, confidence interval; CR, complete response; EEC, endometrioid endometrial carcinoma; LNG-IUS, levonorgestrel-releasing intrauterine system; MA, megestrol-acetate; MPA, Medroxyprogesterone-acetate.

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Source: PubMed

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