Clinicopathological analysis of fertility-sparing treatment and pregnancy outcomes in young women with early-stage endometrial carcinoma

Background: Although the peak incidence of endometrial carcinoma is in postmenopausal women, it affects young women who wish to preserve fertility. The aim of this study was to assess oncologic and reproductive outcomes of fertility-sparing treatment using hysteroscopic resection followed by progesterone for early-stage endometrial carcinoma in young women in the western region of China. Methods: Retrospective analysis is used for analyzing the clinicopathological data, recent curative effect, and pregnancy outcomes of eight patients with early-stage endometrial carcinoma, who were managed conservatively for fertility-sparing purposes in West China Second University Hospital, Sichuan University from June 16, 2008, to December 31, 2010. Results: We evaluated eight patients whose median age was 31 years (range 23-37 years). The median follow-up time was 79.5 months (range 63-93 months) and none had recurrence yet. Of the eight patients, six had endometrial carcinoma (stage IA, G1-2) and two had malignant endometrial polyps. Five cases were treated by hysteroscopic resection followed by administration of high-dose progesterone, and the other three cases, after being pathologically tested with hysteroscopy, were changed to radical treatment or radiotherapy. In five cases who were received hormone therapy, four had successful pregnancies (three conceived naturally, and one used artificial reproductive technology) a median 7.5 months from the end of therapy (range 1-12 months), resulting in three live births. While three patients delivered at term via a cesarean section, one patient had an induced abortion on account of family considerations. The remaining patient failed to become pregnant due to the complications of polycystic ovary syndrome (PCOS). Conclusions: Combination of hysteroscopic resection and progesterone therapy represent a safe and feasible conservative management of early-stage endometrial carcinoma in selected patients wishing to preserve fertility. Key factors to success with this approach include choosing suitable cases under accurate clinicopathological diagnosis, thorough patient counseling, and close postsurgical follow-up.