【摘要】 目的:探讨早期子宫内膜癌(EC)及子宫内膜不典型增生(AH)患者行保留生育力治疗并达到完全缓解(CR)后疾病复发及妊娠结局的相关影响因素。方法:回顾性分析2012年1月1日至2024年12月31日就诊于中南大学湘雅三医院妇科诊断为早期EC及AH行保留生育力治疗后达到CR的108例患者的临床资料。通过Logistic回归分析影响复发、妊娠及活产的相关因素,比较不同治疗方式[口服高效孕激素(孕激素组)、宫内置入左炔诺孕酮宫内节育系统(LNG-IUS)(LNG-IUS组)以及两种方法联合治疗(联合治疗组)]患者的复发及妊娠结局。结果:(1)高体质量指数(BMI)(OR1.22,95%CI 1.05～1.41)、合并多囊卵巢综合征(PCOS)(OR3.30,95%CI 1.24～8.81)及联合治疗(OR0.12,95%CI 0.03～0.42)是影响行保留生育力治疗后早期EC和AH复发的独立因素(P <0.05)。复发患者达到CR时间与出现复发时间呈负相关(r=-0.336,P <0.05)。(2)辅助生殖技术(ART)妊娠方式(OR2.49,95%CI 1.05～5.86)和联合治疗(OR3.07,95%CI 1.09～8.67)是影响妊娠的独立因素(P <0.05)。(3)ART妊娠方式(OR15.55,95%CI 1.62～149.50)和联合治疗(OR23.15,95%CI 2.05～260.90)也是影响活产的独立因素(P <0.05)。(4)联合治疗组的复发率(12.20%)低于孕激素组(44.44%)和LNG-IUS组(54.84%),联合治疗组的活产率(58.54%)高于孕激素组(17.65%)和LNG-IUS组(12.90%),以上差异均有统计学意义(P <0.05)。结论:早期EC和AH行保留生育力治疗后,BMI值越大、合并PCOS是其复发的高危因素,治疗达到CR的时间越短,可能越晚出现复发。联合治疗方式在降低复发率,以及联合治疗和ART助孕在妊娠率和活产率方面存在显著优势。更多还原

【Abstract】 Objective:To investigate the factors associated with disease recurrence and pregnancy outcomes in patients with early-stage endometrial carcinoma(EC)and atypical endometrial hyperplasia(AH)who achieved complete remission(CR)after fertility-sparing treatment. Methods:A retrospective analysis was conducted on clinical data from108patients diagnosed with early-stage EC or AH who achieved CR after fertility-sparing treatment at the Department of Gynecology,The Third Xiangya Hospital of Central South University,between January1,2012,and December31,2024. Logistic regression analysis was performed to identify independent factors influencing recurrence,pregnancy,and live birth. The recurrence and pregnancy outcomes were compared among patients receiving different treatment modalities,including oral high-efficiency progestogens(progestogen group),levonorgestrel-releasing intrauterine system(LNG-IUS group),and combined treatment of oral high-efficiency progestogens plus intrauterine LNG-IUS placement(combination therapy group). Results:(1)Higher Body mass index(BMI)(OR1. 22,95% CI1. 05-1. 41),concurrent polycystic ovary syndrome( PCOS)( OR 3. 30,95% CI1. 24-8. 81),and combined therapy(OR 0. 12,95%CI 0. 03-0. 42) were independent factors associated with recurrence of early-stage EC and AH after fertility-sparing treatment(P < 0. 05). In patients who experienced recurrence,the time to achieve CR was negatively correlated with the time to recurrence(r =-0. 336,P < 0. 05).(2)Assisted reproductive technology(ART)-mediated pregnancy(OR2. 49,95%CI1. 05-5. 86) and combined therapy(OR3. 07,95%CI1. 09-8. 67) were independent factors of pregnancy(P < 0. 05).(3)Use of ART(OR 15. 55,95%CI1. 62-149. 50) and combination therapy(OR 23. 15,95% CI 2. 05-260. 90) were independent factors of live birth(P < 0. 05).(4)The recurrence rate in the combination therapy group(12. 20%) was lower than that in the progestogen group(44. 44%)and the LNG-IUS group(54. 84%),while the live birth rate in the combination therapy group(58. 54%)was higher than that in the progestogen group(17. 65%)and the LNG-IUS group(12. 90%). All these differences were statistically significant(P < 0. 05).Conclusions:Higher BMI and concurrent PCOS are high-risk factors for recurrence in patients with early-stage EC and AH after fertility-sparing treatment. A shorter time to achieve CR correlates with a delayed onset of recurrence. The combination therapy demonstrates significant advantages in reducing recurrence,while both combination therapy and ART improve pregnancy and live birth.更多还原