The addition of metformin to progestin therapy in the fertility-sparing treatment of women with atypical hyperplasia/endometrial intraepithelial neoplasia or endometrial cancer: Little impact on response and low live-birth rates

2020 ◽  
Vol 157 (2) ◽  
pp. 348-356
Author(s):  
Stefany Acosta-Torres ◽  
Tricia Murdock ◽  
Rayna Matsuno ◽  
Anna L. Beavis ◽  
Rebecca L. Stone ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Live Birth ◽  
Intraepithelial Neoplasia ◽  
Atypical Hyperplasia ◽  
Birth Rates ◽  
Live Birth Rates ◽  
Fertility Sparing ◽  
Endometrial Intraepithelial Neoplasia ◽  
Progestin Therapy

scholarly journals Neoplasia intraepitelial endometrial: una lesión precursora de cáncer de endometrio

2021 ◽  
Vol 81 (01) ◽  
pp. 75-85
Author(s):  
Ernesto Lara ◽  
Keyword(s):  
Endometrial Cancer ◽  
Endometrial Hyperplasia ◽  
Intraepithelial Neoplasia ◽  
Atypical Hyperplasia ◽  
Classification Systems ◽  
World Health ◽  
Type I ◽  
Female Population ◽  
Typical Sequence ◽  
Endometrial Intraepithelial Neoplasia

Endometrial cancer represents worldwide the sixth most common malignant pathology in the female population, the endometroid type constitutes the most common form, usually developed from a typical sequence of endometrial hyperplasia secondary to sustained exposure to unopposed estrogens balanced by progestogens. Different classification systems for endometrial hyperplasia have been described, the most recent, published by the World Health Organization in 2014, proposes two categories: 1) hyperplasia without atypia, and 2) atypical hyperplasia or endometrial intraepithelial neoplasia. This classification avoids confusion due to the different terms in use and reflects a better understanding of the pathology behavior. Atypical hyperplasia or endometrial intraepithelial neoplasia is considered a precursor lesion to endometrial carcinoma type I. Health professionals must handle standardized terminology, accurately diagnose this entity, and ensure proper treatment of it. Keywords: Endometrial intraepithelial neoplasia, Endometrial hyperplasia, Atypical hyperplasia, Endometrial cancer.

COMPARISON OF ENDOMETRIAL INTRAEPITHELIAL NEOPLASIA & WHO CLASSIFIED ENDOMETRIAL HYPERPLASIA IN PREDICTING THE RISK OF PROGRESSION TO ENDOMETRIAL CARCINOMA

2021 ◽  
pp. 59-61
Author(s):  
Bansi Kavar ◽  
Neeru Dave
Keyword(s):  
Endometrial Cancer ◽  
Endometrial Hyperplasia ◽  
Intraepithelial Neoplasia ◽  
Atypical Hyperplasia ◽  
Cytological Atypia ◽  
Endometrial Intraepithelial Neoplasia ◽  
Risk Of Progression ◽  
Classi Cation ◽  
Cation System ◽  
Sampling Procedures

Background: Endometrial hyperplasia is the precursor lesion of most endometrial cancers of endometrioid type. The most commonly used classication system for endometrial hyperplasia is WHO 1994 classication system in which architecture disruption and cytological atypia are used to identify four types of endometrial hyperplasia including simple or complex hyperplasia with or without atypia. Newer EIN diagnosis by cytological atypia is of great consideration for the progression to endometrial cancer. Material And Methods: The study consists of 100 cases of WHO classied endometrial hyperplasia for period of 4 yrs from 2015 to 2019. Type of sampling procedures- dilation & curettage, endometrial biopsy and fractional curettage. Objective: 1. To discuss revised criteria for recognition of endometrial intraepithelial neoplasia (EIN). 2. To nd out the sensitivity of endometrial intraepithelial neoplasia (EIN) classication in predicting the risk of malignancy. Results: This study consists of 100 cases of endometrial hyperplasia. Patients were mostly postmenopausal & presented with abnormal vaginal bleeding. From WHO classied endometrial lesions, 2 out of 35 cases of simple typical hyperplasia, 10 out of 14 cases of complex typical hyperplasia,12 out of 20 cases of simple atypical hyperplasia and 20 out of 21 cases of complex atypical hyperplasia were reclassied as EI N. Conclusion: To estimate the risk of progression to carcinoma and guide clinical management, the histo-pathologic diagnosis of endometrial hyperplastic lesion is very important, specially the diagnosis of EIN lesions. EIN carries a much greater risk of progression to endometrial cancer than other WHO classied endometrial hyperplasia.

scholarly journals Outcomes of women treated with progestin and metformin for atypical endometrial hyperplasia and early endometrial cancer: a systematic review and meta-analysis

2021 ◽  
pp. ijgc-2021-002699
Author(s):  
Jennifer Chae-Kim ◽  
Gunjal Garg ◽  
Larisa Gavrilova-Jordan ◽  
Lindsay E Blake ◽  
Tongil "TI" Kim ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Live Birth ◽  
Endometrial Hyperplasia ◽  
Meta Analysis ◽  
Disease Remission ◽  
Atypical Endometrial Hyperplasia ◽  
Fertility Sparing ◽  
Progestin Therapy ◽  
Reproductive Aged Women ◽  
Relapse Rates

ObjectiveProgestin therapy is the recommended fertility-sparing management of atypical endometrial hyperplasia or early-stage endometrial cancer in reproductive-aged women. Our objective was to evaluate disease relapse after progestin and metformin versus progestin therapy alone in patients with endometrial hyperplasia or cancer. Our secondary outcomes were disease remission, clinical pregnancy and live birth rate.MethodsA systematic review of the literature was conducted (MEDLINE, Web of Science, Cochrane Library, CINAHL, LILACS, clinicaltrials.gov) from inception to April 2021. Studies of reproductive-aged women with atypical endometrial hyperplasia or early endometrial cancer who received progestin and metformin or progestin alone for fertility-sparing management, were included in the review. Early endometrial cancer was defined as grade 1, stage 1 disease. Exclusion criteria included women with higher grade endometrial cancer and when conservative management was not for fertility-sparing purposes. Data are presented as odds ratios (ORs) and 95% confidence intervals (CIs) with fixed or random effects meta-analysis. Quality scoring was based on the Newcastle-Ottawa and Jadad scales.ResultsIn total, 271 reports were identified and six studies met the inclusion criteria. These studies included 621 women; 241 (38.8%) patients received combined therapy and 380 (61.2%) received progestin therapy alone. Relapse rates were lower for progestin and metformin than for progestin therapy alone (pooled OR 0.46, 95% CI 0.24 to 0.91, p=0.03). The remission rates were not different (pooled OR 1.35, 95% CI 0.91 to 2.00, p=0.14). Women who received progestin and metformin achieved pregnancy and live birth rates similar to those who received progestin therapy only (pooled OR 1.01, 95% CI 0.44 to 2.35, p=0.98; pooled OR 0.46, 95% CI 0.21 to 1.03, p=0.06).ConclusionFor reproductive-aged women with atypical endometrial hyperplasia or early endometrial cancer, progestin and metformin therapy compared with progestin therapy alone is associated with lower relapse rates, and similar remission, clinical pregnancy and live birth rates.PROSPERO registration numberCRD42020179069.disease remission,

scholarly journals MINIMALLY INVASIVE FERTILITY SPARING TREATMENT IN NON-TUBAL ECTOPIC PREGNANCIES CAN RESULT IN HIGH SUBSEQUENT LIVE BIRTH RATES

2020 ◽  
Vol 114 (3) ◽  
pp. e194
Author(s):  
Katherine E. Kostroun ◽  
Kathryn M. Goldrick ◽  
Jennifer F. Knudtson ◽  
Alia M. Yaghi ◽  
Cheria C. Brown ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Live Birth ◽  
Birth Rates ◽  
Live Birth Rates ◽  
Fertility Sparing ◽  
Ectopic Pregnancies

Long-Term Oncologic and Reproductive Outcomes in Young Women With Early Endometrial Cancer Conservatively Treated: A Prospective Study and Literature Update

2016 ◽  
Vol 26 (9) ◽  
pp. 1650-1657 ◽  
Author(s):  
Giuseppe Laurelli ◽  
Francesca Falcone ◽  
Maria Stella Gallo ◽  
Felice Scala ◽  
Simona Losito ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Prospective Study ◽  
Live Birth ◽  
Reproductive Outcomes ◽  
Birth Rates ◽  
Live Birth Rates ◽  
Stage Ia ◽  
Definitive Surgery

ObjectiveThis study aimed to analyze the long-term oncologic and reproductive outcomes in endometrial cancer (EC) in young patients conservatively treated by combined hysteroscopic resection (HR) and levonorgestrel intrauterine device (LNG-IUD).MethodsTwenty-one patients (age ≤ 40 years; Stage IA, G1-2 endometrioid EC), wishing to preserve their fertility, were enrolled into this prospective study. The HR was used to resect (1) the tumor lesion, (2) the endometrium adjacent to the tumor, and (3) the myometrium underlying the tumor. Hormonal therapy consisted of LNG-IUD (52 mg) for at least 6 months.ResultsThe median follow-up time is 85 months (range, 30–114). After 3 months from the progestin start date, 18 patients (85.7%) showed a complete regression (CR), 2 (9.5%) showed persistent disease, whereas 1 patient (4.8%) presented with progressive disease and underwent definitive surgery (Stage IA, G3 endometrioid). At 6 months, 1 of the 2 persistences underwent definitive surgery (Stage IA, G1 endometrioid), whereas the other was successfully re-treated. Two recurrences (10.5%) were observed, both involving the endometrium and synchronous ovarian cancer (OC) (atypical hyperplasia and Stage IIB G1 endometrioid OC; Stage IA endometrioid G1 EC, and Stage IA G1 endometrioid OC). The median duration of complete response was 85 months (range, 8–117). Sixty-three percent of complete responders attempted to conceive with 92% and 83% pregnancy and live birth rates, respectively. To date, all patients are alive and have no evidence of disease.ConclusionsAfter a long follow-up, combined HR and LNG-IUD would seem to improve the efficacy of progestin alone. High pregnancy and live birth rates were observed in women attempting to conceive. This approach is still experimental and should be offered only in the framework of scientific protocols conducted in cancer centers.

scholarly journals Weight loss improve pregnancy and livebirth outcomes in young women with early-stage endometrial cancer and atypical hyperplasia:15 years’ experience

2021 ◽  
Author(s):  
yanfang zhang ◽  
Dan Li ◽  
Qi Yan ◽  
Jinghua Wang ◽  
fei Teng ◽  
...  
Keyword(s):  
Weight Loss ◽  
Endometrial Cancer ◽  
Live Birth ◽  
Birth Rate ◽  
Early Stage ◽  
Live Birth Rate ◽  
Atypical Hyperplasia ◽  
Fertility Sparing ◽  
Weight Loss Group ◽  
Early Stage Endometrial Cancer

Abstract Background: To evaluate the effects of body weight loss on pregnancy and livebirth outcomes in young women with early-stage endometrial cancer (EC) and atypical hyperplasia (AH) with fertility-sparing therapy. Thus, improve the management of this patient group.Method: Patients with AH (n=36) and well-differentiated EC (n=8, FIGO stage IA) who achieved complete regression after conservative treatment were included in this retrospective study. A weight loss group (n=25) and a non-weight loss group (n=19) were divided; while subgroup analysis according to body mass index and stratification analysis according to weight loss proportion were performed to investigate the effect of weight loss on pregnancy and livebirth outcomes. A univariate and multivariate logistic regression analysis were undertaken to analysis the factors associated with pregnancy.Results: The mean body weight and body mass index at pretreatment of progestin and initiation of fertility treatment was 70.63±12.03 and 67.08±8.18 kg, respectively, and 27.06±4.44 and 25.73±3.15 kg/m2, respectively. 25 patients (56.82%) had weight loss; the median weight loss amount is 5.00kg (1.00-34.50), median weigh loss proportion was 6.70% (1.00-36.00) during median time interval of 12months (5.00-97.00). An impressive favorable pregnancy rate (65.91%) and live birth rate (50.00%) were achieved. The pregnancy and livebirth rate were meaningfully higher in the weight loss group than the non-weight loss group (88.00% vs.36.84%,P=0.000; 64.00% vs.31.58%,P=0.033, respectively); weight loss≥5% significantly increased pregnancy and live birth rate in patients with BMI≥25. The risk ratios of weight loss≥5% in multivariate logistic analysis for pregnancy was 0.096(0.010, 0.907).Conclusions: Weight loss could have a positive effect on pregnancy rates and seem to be useful for improving live birth rates in overweight or obese women with early-stage endometrial cancer and atypical hyperplasia during/after fertility-sparing therapy. weight loss≥5% was protective factors of pregnancy in fertility-sparing patients with early-stage endometrial cancer and atypical hyperplasia.

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