Clinical features and outcome of 15 patients with recurrent endometrial cancer or atypical endometrial hyperplasia received primary fertility-sparing therapy followed by hysterectomy

Objective To investigate the clinical features and outcome of recurrent endometrial cancer (EC) or atypical endometrial hyperplasia (AEH) patients who underwent hysterectomy after fertility-sparing therapy. Methods Clinical data was retrospectively collected for 15 recurrent endometrial cancer or atypical endometrial hyperplasia patients who underwent hysterectomy in six hospitals from 2003 to 2019. According to the indicators of hysterectomy, patients were divided into four groups: 7 patients who underwent direct hyesterectomy after the first relapse, 4 due to re-treatment failure, 1 after full term live birth, and 3 because of multiple recurrence. Clinical coexisting conditions, regimen and outcome of fertility-sparing therapy, pre- and post-operative pathological results, and prognosis were analyzed. Results (1) Fertility-spraring treatment was given to a total of 15 eligible patients, including 6 with EC and 9 with AEH. Median time interval from remission to recurrence was 12 months (range 3–92). Oral progestin-based medicine was the main fertility-sparing therapy in both primary treatment and re-treatment after recurrence. Six (6/8) patients received progestin combined with gonadotrophin releasing hormone agonist or metformin in three re-treatment groups. (2) Nine patients underwent hysterectomy and 6 staging surgery. Three patients had pathological upgrade after surgery. Five (5/10) EC patients had superficial myometrial invasion in postoperative pathology. All patients showed no evidence of disease in the median follow-up of 17 months (range 3–118). (3) Among seven patients who failed to re-treatment and had multiple recurrence, six were overweight/obesity and six had insulin resistance. Two of these patients had synchronous ovarian cancer in the postoperative pathology. Conclusion For the patients with recurrent EC or AEH after primary fertility-sparing therapy, overweight/obesity and insulin resistance might be the risk factors for re-treatment failure. Hysterectomy is recommended when patients had re-treatment failure or multiple recurrence; and generally the prognosis is favorable.