TY - JOUR
T1 - Long-term outcomes of progestin plus metformin as a fertility-sparing treatment for atypical endometrial hyperplasia and endometrial cancer patients
AU - Mitsuhashi, Akira
AU - Habu, Yuji
AU - Kobayashi, Tatsuya
AU - Kawarai, Yoshimasa
AU - Ishikawa, Hiroshi
AU - Usui, Hirokazu
AU - Shozu, Makio
N1 - Publisher Copyright:
© 2019. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology.
PY - 2019/11
Y1 - 2019/11
N2 - Objective: The present study investigated long-term outcomes of medroxyprogesterone acetate (MPA) plus metformin therapy in terms of control of atypical endometrial hyperplasia (AEH) and endometrial cancer (EC), and post-treatment conception. Methods: We retrospectively analyzed 63 patients (42 with EC; 21 with AEH) who underwent fertility-sparing management using MPA plus metformin. MPA (400 mg/day) and metformin (750–2,250 mg/day) were administered to achieve complete response (CR). Metformin was administered until conception, even after MPA discontinuation. Results: Of the total patients, 48 (76%) had a body mass index (BMI) ≥25 kg/m2 and 43 (68%) showed insulin resistance. Sixty-one patients (97%) achieved CR within 18 months. CR rates at 6, 8–9, and 12 months were 60%, 84%, and 90%, respectively. During a median follow-up period of 57 months (range, 13–115 months), relapse occurred in 8 of 61 patients (13.1%) who had achieved CR. Relapse-free survival (RFS) in all patients at 5 years was 84.8%. Upon univariate analysis, patients with BMI ≥25 kg/m2 had significantly better prognoses than did those with BMI <25 kg/m2 (odds ratio=0.19; 95% confidence interval=0.05–0.66; p=0.009). Overall pregnancy and live birth rates per patient were 61% (19/31) and 45% (14/31), respectively. Conclusions: MPA plus metformin is efficacious in terms of RFS and post treatment conception. Moreover, metformin may be more efficacious for patients with BMI ≥25 kg/m2.
AB - Objective: The present study investigated long-term outcomes of medroxyprogesterone acetate (MPA) plus metformin therapy in terms of control of atypical endometrial hyperplasia (AEH) and endometrial cancer (EC), and post-treatment conception. Methods: We retrospectively analyzed 63 patients (42 with EC; 21 with AEH) who underwent fertility-sparing management using MPA plus metformin. MPA (400 mg/day) and metformin (750–2,250 mg/day) were administered to achieve complete response (CR). Metformin was administered until conception, even after MPA discontinuation. Results: Of the total patients, 48 (76%) had a body mass index (BMI) ≥25 kg/m2 and 43 (68%) showed insulin resistance. Sixty-one patients (97%) achieved CR within 18 months. CR rates at 6, 8–9, and 12 months were 60%, 84%, and 90%, respectively. During a median follow-up period of 57 months (range, 13–115 months), relapse occurred in 8 of 61 patients (13.1%) who had achieved CR. Relapse-free survival (RFS) in all patients at 5 years was 84.8%. Upon univariate analysis, patients with BMI ≥25 kg/m2 had significantly better prognoses than did those with BMI <25 kg/m2 (odds ratio=0.19; 95% confidence interval=0.05–0.66; p=0.009). Overall pregnancy and live birth rates per patient were 61% (19/31) and 45% (14/31), respectively. Conclusions: MPA plus metformin is efficacious in terms of RFS and post treatment conception. Moreover, metformin may be more efficacious for patients with BMI ≥25 kg/m2.
KW - Atypical Endometrial Hyperplasia
KW - Endometrial Cancer
KW - Fertility Preservation
KW - Insulin Resistance
KW - Medroxyprogesterone Acetate
KW - Metformin
UR - http://www.scopus.com/inward/record.url?scp=85072847975&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85072847975&partnerID=8YFLogxK
U2 - 10.3802/jgo.2019.30.e90
DO - 10.3802/jgo.2019.30.e90
M3 - Article
C2 - 31576686
AN - SCOPUS:85072847975
SN - 2005-0380
VL - 30
JO - Journal of Gynecologic Oncology
JF - Journal of Gynecologic Oncology
IS - 6
M1 - e90
ER -