Analysis of risk factors for recurrence in infertile endometrial cancer patients after in vitro fertilization treatment

Hongyi Wei; Ningning Pan; Yang Wang; Caihong Ma

doi:10.3389/fendo.2023.1224622

Analysis of risk factors for recurrence in infertile endometrial cancer patients after in vitro fertilization treatment

Front Endocrinol (Lausanne). 2023 Nov 22:14:1224622. doi: 10.3389/fendo.2023.1224622. eCollection 2023.

Authors

Hongyi Wei^{1

2}, Ningning Pan^{1

3

4

5}, Yang Wang^{1

3

4

5}, Caihong Ma^{1

3

4

5}

Affiliations

¹ Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.
² Department of Obstetrics and Gynecology, Peking University International Hospital, Beijing, China.
³ National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.
⁴ Key Laboratory of Assisted Reproduction, Ministry of Education, Peking University, Beijing, China.
⁵ Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Peking University Third Hospital, Beijing, China.

Abstract

Purpose: To investigate the oncologic outcomes of patients with early-stage endometrioid endometrial cancer (EEC) treated with in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) following fertility-sparing treatment (FST).

Methods: A total of 62 patients who underwent IVF/ICSI treatment in a single fertility center between June 2010 and December 2021 after conservative treatment for early-stage EEC were assigned to a recurrence group and a non-recurrence group. Their clinical characteristics and disease outcomes were retrospectively evaluated.

Results: The 62 women with complete remission (CR) after FST for EEC underwent 103 IVF cycles, resulting in 41 fresh embryo transfers (ETs) and 70 frozen-thawed transfers; 27 (43.55%) achieved clinical pregnancies, and 20 (32.26%) gave birth to a total of 23 live neonates. Additionally, nine patients had live births from natural pregnancies after IVF failure, bringing the cumulative live birth rate to 46.77% (29/62). After a median follow-up period of 53.88 months (range 20.2-127.5 months), 17 patients (27.42%) experienced recurrence within 2.8 to 57.9 months after the first controlled ovarian stimulation (COS). The probability of relapse at 1, 2, and 3 years after the initiation of COS was 14.52% (9/62), 21% (13/62), and 25.81% (16/62), respectively. Factors such as the time to CR, the time to IVF, the frequency of COS, maintenance treatment before IVF, and histology type were not found to significantly affect recurrence (p = 0.079, 0.182, 0.093, 0.267, and 0.41, respectively). Live births (hazard ratio (HR): 0.28, 95% CI: 0.082-0.962, p = 0.043) and the protocol of letrozole plus gonadotropin-releasing hormone (GnRH) antagonist/agonist used during IVF (HR: 0.1, 95% CI: 0.011-0.882, p = 0.038) were identified as independent favorable factors for recurrence.

Conclusions: Live birth was associated with decreased recurrence of EEC. Reducing estrogen levels during COS may serve to mitigate the risk of endometrial cancer recurrence.

Keywords: assisted reproductive technology; controlled ovarian stimulation; endometrial cancer; fertility preservation; in vitro fertilization; recurrence.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Endometrial Neoplasms*
Female
Fertilization in Vitro / methods
Humans
Infant, Newborn
Infertility* / therapy
Male
Neoplasm Recurrence, Local / epidemiology
Pregnancy
Pregnancy Rate
Retrospective Studies
Risk Factors
Semen

Grants and funding

This study was supported by Clinical Cohort Construction Program of Peking University Third Hospital. No. BYSYDL2022011.