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

Obstet Gynecol. 2013 Jan;121(1):136-42. doi: 10.1097/aog.0b013e31827a0643.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • 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

Substances

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