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

• Published in: Frontiers in endocrinology (Lausanne) Vol. 14; p. 1224622
• Main Authors: Wei, Hongyi, Pan, Ningning, Wang, Yang, Ma, Caihong
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 2023
• Subjects: assisted reproductive technology; controlled ovarian stimulation; endometrial cancer; Endometrial Neoplasms; Female; fertility preservation; Fertilization in Vitro - methods; Humans; in vitro fertilization; Infant, Newborn; Infertility - therapy; Male; Neoplasm Recurrence, Local - epidemiology; Pregnancy; Pregnancy Rate; recurrence; Retrospective Studies; Risk Factors; Semen; recurrence; endometrial cancer; in vitro fertilization; assisted reproductive technology; fertility preservation; controlled ovarian stimulation
• ISSN: 1664-2392; 1664-2392
• DOI: 10.3389/fendo.2023.1224622

To investigate the oncologic outcomes of patients with early-stage endometrioid endometrial cancer (EEC) treated with fertilization/intracytoplasmic sperm injection (IVF/ICSI) following fertility-sparing treatment (FST). 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. 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 ( = 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, = 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, = 0.038) were identified as independent favorable factors for recurrence. Live birth was associated with decreased recurrence of EEC. Reducing estrogen levels during COS may serve to mitigate the risk of endometrial cancer recurrence.