The clinical and reproductive outcomes of endometrial intraepithelial neoplasia: experience of 117 cases

Yıl 2023, Cilt: 23 Sayı: 3, 52 - 57, 28.12.2023

Burak Giray Emin Erhan Dönmez Fatih Kaya Hamdullah Sözen Yavuz Salihoglu Samet Topuz Doğan Vatansever

https://doi.org/10.59215/trsgo.1292019

Öz

Aim: Hysterectomy is the suggested treatment for endometrial intraepithelial neoplasia since there is a high risk of coexisting endometrial adenocarcinoma in this subset of patients. However, fertility sparing treatment modalities can also be an option for patients with endometrial intraepithelial neoplasia who desire to preserve their fertility. In this study our aim was to evaluate the clinical and reproductive outcomes of endometrial intraepithelial neoplasia.

Materials and methods: We retrospectively analyzed the records of 117 patients with atypical hyperplasia (AH)/endometrial intraepithelial neoplasia (EIN) in a tertiary gynecological cancer center. The median follow-up time was 54 (7-96) months.

Results: One hundred and one women underwent hysterectomy. The rate of coexistent endometrial carcinoma in women with AH/EIN was 33.7%. Sixteen women were treated conservatively. The complete response rate was 75% in patients after a treatment period of 12 months. Four of the patients in the infertile group had a successful live birth, 2 spontaneously and 2 with in vitro fertilization. Two patients in the fertile group had a successful live birth, 2 spontaneously.

Conclusion: Fertility sparing management is a feasible option for patients with atypical hyperplasia. However, it is crucial that there are high rates of coexisting endometrial cancer in these patients. Patients with AH/EIN should be followed up carefully for endometrial adenocarcinoma with regular endometrial samplings.

Anahtar Kelimeler

Endometrial Hyperplasia, Endometrial Intraepithelial Neoplasia, Endometrial Cancer, Fertility-Sparing Treatment

Endometrial i̇ntraepitelyal neoplazinin klinik ve repordüktif sonuçları: 117 vakanın deneyimi

Öz

Amaç: Histerektomi, endometrial intraepitelyal neoplazi için önerilen tedavidir, çünkü bu hasta alt grubunda endometrial adenokarsinom ile birliktelik riski yüksektir. Bununla birlikte, fertilitesini korumak isteyen endometrial intraepitelyal neoplazili hastalar için fertilite koruyucu tedavi modaliteleri de bir seçenek olabilir. Bu çalışmada amacımız endometriyal intraepitelyal neoplazinin klinik ve reprodüktif sonuçlarını değerlendirmektir.

Gereç ve yöntem: Üçüncül bir jinekolojik kanser merkezinde atipik hiperplazi (AH)/endometrial intraepitelyal neoplazi (EIN) olan 117 hastanın kayıtlarını retrospektif olarak incelendi. Median takip süresi 54 (7-96) aydır.

Bulgular: Yüz bir kadına histerektomi yapıldı. AH/EIN’li kadınlarda eşlik eden endometriyal karsinom oranı %33,7 idi. On altı kadın konservatif olarak tedavi edildi. 12 aylık tedavi süresinden sonra hastalarda tam yanıt oranı %75 idi. İnfertil gruptaki hastaların 2’si spontan, 2’si tüp bebek ile olmak üzere 4’ü başarılı bir canlı doğum gerçekleştirdi. Fertil grupdaki 2 hasta spontan olarak başarılı 2 canlı doğum gerçekleştirdi.

Sonuç: Atipik hiperplazisi olan hastalar için fertilite koruyucu tedavi uygulanabilir bir seçenektir. Bununla birlikte, bu hastalarda yüksek oranda birliktelik gösteren endometrial kanser oranları çok önemlidir. AH/EIN’li hastalar, düzenli endometrial örneklemeler ile endometriyal adenokarsinom açısından dikkatle izlenmelidir.

Anahtar Kelimeler

Endometriyal Hiperplazi, Endometriyal İntraepitelyal Neoplazi, Endometriyal Kanser, Fertilite Koruyucu Tedavi

Kaynakça

• Sobczuk K, Sobczuk A. New classification system of endometrial hyperplasia WHO 2014 and its clinical implications. Prz Menopauzalny. 2017;16(3):107-111.
• Rakha E, Wong SC, Soomro I, Chaudry Z, Sharma A, Deen S, et al. Clinical outcome of atypical endometrial hyperplasia diagnosed on an endometrial biopsy: institutional experience and review of literature. Am J Surg Pathol. 2012;36(11):1683-90.
• Simpson AN, Feigenberg T, Clarke BA, Gien LT, Ismiil N, Laframboise S, et al. Fertility sparing treatment of complex atypical hyperplasia and low grade endometrial cancer using oral progestin. Gynecol Oncol. 2014;133(2):229-33.
• Robbe EJ, van Kuijk SM, de Boed EM, Smits LJ, van der Wurff AA, Kruitwagen RF, et al. Predicting the coexistence of an endometrial adenocarcinoma in the presence of atypical complex hyperplasia: immunohistochemical analysis of endometrial samples. Int J Gynecol Cancer. 2012;22(7).
• Matanes E, Amajoud Z, Kogan L, Mitric C, Ismail S, Raban O, et al. Is sentinel lymph node assessment useful in patients with a preoperative diagnosis of endometrial intraepithelial neoplasia? Gynecol Oncol. 2023;168:107-13.
• Koskas M, Uzan J, Luton D, Rouzier R, Daraï EJF, sterility. Prognostic factors of oncologic and reproductive outcomes in fertility-sparing management of endometrial atypical hyperplasia and adenocarcinoma: systematic review and meta-analysis. Fertil Steril. 2014;101(3):785-94.
• Brownfoot FC, Hickey M, Ang WC, Arora V, McNally O. Complex atypical hyperplasia of the endometrium: differences in outcome following conservative management of pre-and postmenopausal women. Reprod Sci. 2014;21(10):1244-8.
• Tavassoli FA. World Health Organisation Classification of Tumors: Pathology and Genetics of Tumors of the Breast and Female Genital Organs. Lyon, France: IARC Press; 2003.
• Trimble CL, Method M, Leitao M, Lu K, Ioffe O, Hampton M, et al; Society of Gynecologic Oncology Clinical Practice Committee. Management of endometrial precancers. Obstet Gynecol. 2012;120(5):1160-75.
• Corzo C, Santillan NB, Westin SN, Ramirez PT. Updates on conservative management of endometrial cancer. J Minim Invasive Gynecol. 2018;25(2):308-13.
• Kender Erturk N, Basaran D, Salman C. Comparison of endometrial cancer risk in patients with endometrial precancerous lesions: WHO 1994 vs EIN classification. J Obstet Gynaecology. 2022;42(4):692-5.
• Vetter MH, Smith B, Benedict J, Hade EM, Bixel K, Copeland LJ, et al. Preoperative predictors of endometrial cancer at time of hysterectomy for endometrial intraepithelial neoplasia or complex atypical hyperplasia. Am J Obstet Gynecol. 2020;222(1):60. e1-. e7.
• Ota T, Yoshida M, Kimura M, Kinoshita K. Clinicopathologic study of uterine endometrial carcinoma in young women aged 40 years and younger. Int J Gynecol Cancer.. 2005;15(4) :657-62.
• Wang Q, Guo Q, Gao S, Xie F, Du M, Dong J, et al. Fertility-conservation combined therapy with hysteroscopic resection and oral progesterone for local early stage endometrial carcinoma in young women. Int J Clin Exp Med. 2015;8(8):13804.
• Kim MK, Seong SJ, Kim J-W, Jeon S, Choi HS, Lee I-H, et al. Management of endometrial hyperplasia with a levonorgestrel-releasing intrauterine system: a Korean Gynecologic-Oncology Group Study. Int J Gynecol Cancer. 2016;26(4):711-5.
• Han AR, Kwon Y-S, Kim D, Kim J, Kim Y, Kim Y, et al. Pregnancy outcomes using assisted reproductive technology after fertility-preserving therapy in patients with endometrial adenocarcinoma or atypical complex hyperplasia. Int J Gynecol Cancer. 2009;19(1):147-51.
• Guillon S, Popescu N, Phelippeau J, Koskas M. A systematic review and meta-analysis of prognostic factors for remission in fertility-sparing management of endometrial atypical hyperplasia and adenocarcinoma. Int J Gynaecol Obstet. 2019;146(3):277-288.
• Fan Z, Li H, Hu R, Liu Y, Liu X, Gu L. Fertility-preserving treatment in young women with grade 1 presumed stage IA endometrial adenocarcinoma: a meta-analysis. Int J Gynecol Cancer. 2018;28(2):385-393.
• He Y, Wang Y, Zhou R, Wang. Oncologic and obstetrical outcomes after fertility-preserving retreatment in patients with recurrent atypical endometrial hyperplasia and endometrial cancer. Int J Gynecol Cancer. 2020;30(12):1902-1907.
• Ohyagi-Hara C, Sawada K, Aki I, Mabuchi S, Kobayashi E, Ueda Y, et al. Efficacies and pregnant outcomes of fertility-sparing treatment with medroxyprogesterone acetate for endometrioid adenocarcinoma and complex atypical hyperplasia: our experience and a review of the literature. Arch Gynecol Obstet. 2015;291:151-7.
• Ayhan A, Tohma YA, Tunc M. Fertility preservation in early-stage endometrial cancer and endometrial intraepithelial neoplasia: A single-center experience. Taiwan J Obstet Gynecol. 2020;59(3):415-9.
• Walsh C, Holschneider C, Hoang Y, Tieu K, Karlan B, Cass I. Coexisting ovarian malignancy in young women with endometrial cancer. Obstet Gynecol. 2005;106(4):693-9.
• Morice P, Fourchotte V, Sideris L, Gariel C, Duvillard P, Castaigne D. A need for laparoscopic evaluation of patients with endometrial carcinoma selected for conservative treatment. Gynecol Oncol. 2005;96(1):245-8.
• Navarria I, Usel M, Rapiti E, Neyroud-Caspar I, Pelte M-F, Bouchardy C, et al. Young patients with endometrial cancer: how many could be eligible for fertility-sparing treatment? Gynecol Oncol. 2009;114(3):448-51.