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IVF impact on the risk of recurrence of endometrial adenocarcinoma after fertility-sparing management

  • Maïlys Vaugon
    Correspondence
    Corresponding author.
    Affiliations
    AP-HP, Department of Obstetrics and Gynecology, Hôpital Bichat-Claude Bernard, Paris, France

    Université de Paris, Paris, France
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  • Maëliss Peigné
    Affiliations
    AP-HP, Department of Reproductive Medicine and Fertility Preservation, Hôpital Jean Verdier, Bondy, France

    Université Sorbonne Paris Nord, Paris, France
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  • Juliette Phelippeau
    Affiliations
    AP-HP, Department of Obstetrics and Gynecology, Hôpital Bichat-Claude Bernard, Paris, France

    Université de Paris, Paris, France
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  • Clémentine Gonthier
    Affiliations
    AP-HP, Department of Obstetrics and Gynecology, Hôpital Bichat-Claude Bernard, Paris, France

    Université de Paris, Paris, France

    Groupe PREFERE (Préservation de la fertilité et cancer de l'endomètre) Hôpital Bichat-Claude Bernard, Paris, France
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  • Martin Koskas
    Affiliations
    AP-HP, Department of Obstetrics and Gynecology, Hôpital Bichat-Claude Bernard, Paris, France

    Université de Paris, Paris, France

    Groupe PREFERE (Préservation de la fertilité et cancer de l'endomètre) Hôpital Bichat-Claude Bernard, Paris, France
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      Abstract

      Research question

      Do IVF treatments after conservative management of endometrial atypical hyperplasia or grade 1 endometrial adenocarcinoma (AH/EC) increase the risk of disease recurrence?

      Design

      This is a prospective cohort study from a national registry from January 2008 to July 2019. Sixty patients had an AH/EC and received progestin treatment using chlormadinone acetate for at least 3 months. After remission, 31 patients underwent IVF and 29 did not.
      The primary outcome was the recurrence rate at 24 months according to the use of IVF. The secondary outcome was the identification of risk factors for recurrence.

      Results

      The probability of 2-year recurrence was 37.7% (SD 10.41%) in the IVF group and 55.7% (SD 14.02%) in the no IVF group (P = 0.13). Obesity, nulliparity, polycystic ovary syndrome, age and tumoural characteristics were not associated with recurrence. Pregnancy was a protective factor for recurrence, with 2-year recurrence probabilities of 20.5% and 62.0% in the pregnancy and no pregnancy groups, respectively (P = 0.002, 95% CI 0.06–0.61). In contrast, the number of cycles, maximum serum oestradiol concentration during ovarian stimulation, ovarian stimulation protocol, total dose of gonadotrophin administered and thickness of the endometrium showed no significant differences in terms of the risk of recurrence in the IVF subgroup.

      Conclusion

      IVF treatment after fertility-sparing management of AH/EC does not increase the risk of recurrence. Therefore, it is an acceptable strategy to decrease the time to pregnancy. Overall, the recurrence rate is high enough to justify close monitoring once remission occurs.

      Key words

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      Biography

      Martin Koskas, MD, PhD is currently professor in the Department of Gynaecological Surgery at APHP, Paris University, France. His clinical practice is focused on oncology, endometriosis and fertility. He founded and now chairs the French Registry for fertility preservation in endometrial cancer and atypical hyperplasia.
      Key Message
      After the fertility-sparing management of endometrial atypical hyperplasia or cancer, IVF does not seem to increase the risk of recurrence. Overall, the recurrence rate is high and justifies close monitoring.