Efficacy and prognosis of fertility-preserved hysteroscopic surgery combined with progesterone in the treatment of complex endometrial hyperplasia and early endometrial carcinoma.

PURPOSE To evaluate the complete response (CR) rate, recurrence rate and pregnancy outcome of complex endometrial hyperplasia (CEH) and early endometrial carcinoma (EC) patients treated with hysteroscopic surgery combined with progesterone, and to analyze the related influencing factors for prognosis. METHODS The clinical data of 96 patients histopathologically diagnosed with CEH or early EC and treated with hysteroscopic surgery combined with levonorgestrel-releasing intrauterine system (LNG-IUS) and/or high-efficient megestrole acetale (MA) in our hospital from January 2014 to January 2016 were retrospectively analyzed. The hysteroscopic examination was performed for patients, and the improvement of endometrium was evaluated via curettage every 3 months after treatment. The recurrence, pregnancy and fertility conditions after CR were recorded through follow-up, and the influencing factors for prognosis were analyzed. RESULTS Among the 96 patients, there were 83 cases (86.5%) of CR and 11 cases (13.3%) of recurrence. Among the CR patients, 76 cases had the desire for pregnancy, and there were 46 cases (60.5%) of natural pregnancy or pregnancy using assisted reproductive technology after treatment. CR was achieved more easily in patients with a body mass index (BMI) <30 kg/m2. Moreover, the BMI <30 kg/m2 and pregnancy after CR could reduce the recurrence rate, and BMI <30 kg/m2 and assisted reproductive technology could improve the pregnancy outcome after remission. CONCLUSIONS For CEH and early EC patients who strongly urge to preserve the fertility, hysteroscopic surgery combined with LNG-IUS and/or high-efficient progesterone can obtain satisfactory efficacy. Strictly controlling the body weight of patients with BMI ≥30kg/m2 can improve the remission rate and pregnancy rate and reduce the recurrence rate. Timely pregnancy after remission can reduce the recurrence rate, and the application of assisted reproductive technology can significantly enhance the pregnancy rate and live birth rate.