Young patients with the endometrial cancer
IA who desire to preserve fertility, can select the conservative therapy with
progestin. However, the therapy involves risks of progression and relapse. We
examined immunohistochemical analyses of phosphatase and tension homolog (PTEN)
and p53 expressions to predict the early relapse, and pregnancy and delivery.
Twenty women with endometrial cancer, FIGO IA (1988) (FIGO staging was
essentially defined post-surgically), instead of the pathogical specimen before
surgery without myometrial invasion were estimated by MRI under 40 years at
Gifu University Hospital, Japan from 1988 to 2009. Patients were treated with
medroxyprogesterone acetate (MPA, 400 - 600 mg/day) for 4 - 10 months, with
whole wall endometrial curettage performed every four weeks. Response to the
therapy, pregnancy, delivery and relapse of disease during follow-up over a
72-month period. Immunohistochemical expression of PTEN and p53 was also
evaluated with pregnancy, delivery and relapse rate. All patients had
pathological complete remissions within 4 - 10 months. Relapse rate was high
(60%) in more than 72 months. Immunohistochemical PTEN retain in tumor cells
before MPA treatment (8/10) was significant better correlation with pregnancy
and delivery rate than of lost cases (1/5) in non-obese women (P < 0.05).
Conservative therapy is feasible in carefully selected young women with
endometrial cancer without myometrial invasion. However, the relapse rate was
high. In cases who desire to be a pregnant, an earlier infertility treatment
may be considered especially for PTEN loss especially in nonobese cases.
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