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Tytuł pozycji:

The addition of metformin to progestin therapy in the fertility-sparing treatment of women with atypical hyperplasia/endometrial intraepithelial neoplasia or endometrial cancer: Little impact on response and low live-birth rates.

Tytuł:
The addition of metformin to progestin therapy in the fertility-sparing treatment of women with atypical hyperplasia/endometrial intraepithelial neoplasia or endometrial cancer: Little impact on response and low live-birth rates.
Autorzy:
Acosta-Torres S; The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Murdock T; Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Matsuno R; Johns Hopkins School of Medicine, Baltimore, MD, USA.
Beavis AL; The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Stone RL; The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Wethington SL; The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Levinson K; The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Grumbine F; The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Ferriss JS; The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Tanner EJ; The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Northwestern University School of Medicine, Chicago, IL, USA.
Fader AN; The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA. Electronic address: .
Źródło:
Gynecologic oncology [Gynecol Oncol] 2020 May; Vol. 157 (2), pp. 348-356. Date of Electronic Publication: 2020 Feb 19.
Typ publikacji:
Journal Article; Research Support, Non-U.S. Gov't
Język:
English
Imprint Name(s):
Original Publication: New York, Academic Press.
MeSH Terms:
Live Birth*
Antineoplastic Combined Chemotherapy Protocols/*administration & dosage
Carcinoma in Situ/*drug therapy
Endometrial Hyperplasia/*drug therapy
Endometrial Neoplasms/*drug therapy
Fertility Preservation/*methods
Adult ; Carcinoma in Situ/pathology ; Cohort Studies ; Endometrial Hyperplasia/pathology ; Endometrial Neoplasms/pathology ; Female ; Humans ; Metformin/administration & dosage ; Neoplasm Recurrence, Local/pathology ; Pregnancy ; Pregnancy Outcome ; Progestins/administration & dosage ; Retrospective Studies
Substance Nomenclature:
0 (Progestins)
9100L32L2N (Metformin)
Entry Date(s):
Date Created: 20200223 Date Completed: 20201030 Latest Revision: 20201030
Update Code:
20240105
DOI:
10.1016/j.ygyno.2020.02.008
PMID:
32085863
Czasopismo naukowe
Objective: Our objectives were 1) to compare the efficacy of progestin therapy combined with metformin (Prog-Met) to Prog alone as primary fertility sparing treatment in women with atypical hyperplasia/endometrial intraepithelial neoplasia (AH/EIN) or early-stage endometrioid carcinoma (EC), and 2) to analyze the proportion of women achieving live birth following treatment.
Methods: A retrospective cohort study of all reproductive-aged women with AH/IN or EC treated with Prog ± Met from 1999-2018 was conducted. Complete response (CR) was assessed and Kaplan-Meier analysis used to calculate time to CR. Comparison of potential response predictors was performed with multivariable Cox regression models.
Results: Ninety-two women met criteria; 59% (n = 54) were treated for AH/EIN and 41% (n = 38) for EC. Their median age, body mass index, and follow up time was 35 years, 37.7 kg/m 2 , and 28.4 months, respectively. Fifty-eight women (63%) received Prog and 34 (37%) received Prog-Met. Overall, 79% (n = 73) of subjects responded to treatment with a CR of 69% (n = 63). There was no difference in CR (p = 0.90) or time to CR (p = 0.31) between the treatment cohorts. Overall, 22% experienced a disease recurrence. On multivariable analysis, EC histology was the only covariate associated with a decreased Prog response (HR 0.48; p = 0.007). Only 17% of the cohort achieved a live-birth pregnancy, the majority of which required assisted reproductive technologies (81%) and occurred in the Prog treatment group.
Conclusions: Our study does not support the use of Prog-Met therapy for treatment of AH/EIN or EC. Additionally, fewer than 20% of women achieved a live-birth pregnancy during the study period, with most requiring ART.
Competing Interests: Declaration of competing interest The authors declare that there is no conflict of interest.
(Copyright © 2020. Published by Elsevier Inc.)

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