Clinical implications of morular metaplasia in fertility-preserving treatment for atypical endometrial hyperplasia and early endometrial carcinoma patients

• Published in: Archives of gynecology and obstetrics Vol. 306; no. 4; pp. 1135 - 1146
• Main Authors: Wu, Pengfei, Lv, Qiaoying, Guan, Jun, Shan, Weiwei, Chen, Xiaojun, Zhu, Qin, Luo, Xuezhen
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2022; Springer Nature B.V
• Subjects: Cancer; Clinical outcomes; Endocrinology; Endometrial cancer; Endometrium; Fertility; Gynecologic Oncology; Gynecology; Human Genetics; Hyperplasia; Medicine; Medicine & Public Health; Obstetrics; Obstetrics/Perinatology/Midwifery; Pathology; Patients; Endometrial metaplasia; Endometrioid carcinoma; Morular metaplasia; Atypical endometrial hyperplasia; Conservative treatment
• ISSN: 1432-0711; 0932-0067; 1432-0711
• DOI: 10.1007/s00404-021-06382-3

Objective Morular metaplasia (MM) is a benign epithelial metaplasia that sometimes appears in atypical endometrial hyperplasia (AEH) and endometrioid endometrial carcinoma (EEC). However, the clinical implications of MM for fertility-preserving treatment in AEH and EEC patients are unclear. This study investigated the clinical features and impact of MM on the efficacy of fertility-preserving treatment. Methods We retrospectively studied 427 AEH and EEC patients who received fertility-preserving treatment. Clinical features, treatment efficacy, and onco-fertility results were compared between patients with and without MM. Results MM appeared in 147 of 427 (34.4%) patients. Among them, 49 (33.3%) had MM only before treatment (BEF group), 32 (21.8%) had sustained MM before and during treatment (SUS group), and 66 (44.9%) had MM only during treatment (DUR group). The BEF group had a higher 12-month CR rate (98.0% vs 85.7%, p  = 0.017) and shorter therapeutic duration to achieve CR (4.0 vs 5.7 months, p  = 0.013) than the non-MM group had. In comparison with the non-MM group, the SUS and DUR groups had a lower CR rate after 7 months of treatment (SUS vs non-MM, 37.5% vs 61.1%, p  = 0.010; DUR vs non-MM 33.3% vs. 61.1%, p  < 0.001), and a longer median therapeutic duration to achieve CR (SUS vs non-MM, 7.6 vs. 4.0 months, p  = 0.037; DUR vs non-MM, 7.9 vs. 4.0 months, p  < 0.001). Conclusion Appearance of MM only before treatment was positively correlated with outcome of fertility-preserving treatment, while sustained MM or appearance of MM only during treatment implied poorer outcome of fertility-preserving treatment in AEH and EEC patients.