Features of the course of pregnancy and childbirth after conservative treatment of initial atypical hyperplasia and endometrial cancer

Background. Survival rates for endometrial cancer have improved in recent decades, so strategies are needed to avoid or reduce reproductive harm caused by cancer treatment. In medicine today, there are questions that do not always have answers. There are not enough works that would analyze and summarize the features that reflect the nature of the course of pregnancy and childbirth, the possibilities of ante- and intrapartum monitoring and the nature of obstetric care, as fundamental factors in the formation of perinatal indicators. In addition, there is extremely insufficient information about the effect of pregnancy on further risks of relapse, which convinces us of the advisability of further study of this problem. Our study allowed us to show the possibility of safe pregnancy and labour in such patients, to evaluate the peculiarities of the course of pregnancy and labour and the long-term prognosis for the woman's health.

Objective. The purpose of our work was to study the characteristics of the course of pregnancy and childbirth in patients after conservative treatment of atypical hyperplasia and endometrial cancer.

Results. The study included 114 patients with spontaneous and induced pregnancy that occurred after conservative treatment of atypical hyperplasia and initial endometrial cancer. The course of the 1st, 2nd and 3rd trimesters of pregnancy, perinatal outcomes and disease-free survival in patients were analyzed.

Conclusion. Our study made it possible to demonstrate the possibility of a safe course of pregnancy and childbirth in such patients, to evaluate the characteristics of the course of pregnancy and childbirth and long-term prognosis for the woman’s health. These results indicate a low recurrence rate of atypical hyperplasia and endometrial cancer after pregnancy, regardless of pregnancy outcome. It should be emphasised that no pregnancy-associated recurrences were observed.

1. Kaprin A. D., Starinsky V. V., Petrova G. V. Malignant neoplasms in Russia in 2015. Moscow: Moscow Scientific and Research Oncological Institute named after P. A. Herzen, branch ofNational Medical Research Radiological Center of the Ministry of Health of the Russian Federation, 2017. 250 p. ISBN 978-5-85502227-8. (In Russ.)

2. Novikova O. V., Lozovaya Yu. A. Fertility indicators in recurrences of atypical hyperplasia and initial endometrial cancer after independent hormone therapy. Reproduktivnye tehnologii v onkologii 2015. 26 p. (In Russ.)

3. Novikova, E. G., Chulkova O. V., Pronin S. M. Treatment of atypical endometrial hyperplasia. Prakticheskaya onkologiya. 1 (4): 52-59. (In Russ.)

4. Novikova O. V., Novikova E. G., Krasnopolskaya K. V., et al. Is it possible to preserve fertility in recurrences after conservative treatment of atypical hyperplasia and initial endometrial cancer? Akusherstvo i ginekologija Sankt-Peterburga. 2017; 4: 45-51. (In Russ.)

5. Novikova O. V., Novikova E. G., Volchenko N. N., et al. Treatment of recurrences of atypical hyperplasia and initial endometrial cancer after self-administered hormone therapy. Akusherstvo i ginekologija: novosti, mnenija, obuchenie. 2018; 1: 68-76. (In Russ.)

6. Novikova O. V., Avasova Ch. A., Novikova E. G., et al. A new variant of hormonal treatment of atypical hyperplasia and initial endometrial cancer with preservation of fertility. Onkoginekologiya. 2019; 1: 36-45. (In Russ.)

7. Urmancheeva A. F. Gynaecological cancer in combination with pregnancy. Prakticheskaya onkologiya. 2009; 4 (10): 184-197. (In Russ.)

8. American Cancer Society. Cancer Facts & Figures 2019. Atlanta : American Cancer Society, 2019. URL: http://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2019/cancer-facts-and-figures-2019.pdf (accessed: 16.10.2019).

9. An-Shine Chao, Angel Chao, Chin-Jung Wang, Chyong-Huey Lai, Hsin-Shih Wang. Obstetric outcomes of pregnancy after conservative treatment of endometrial cancer: Case series and literature review. Taiwanese Journal of Obstetrics and Gynecology. 2011; Vol. 50, Issue 1: 62-66. ISSN 1028-4559. https://doi.org/10.1016/j.tjog.2009.10.006.

10. Baker J., Obermair A., Gebski V., Janda M.Efficacy of oral or intrauterine device-delivered progestin in patients with complex endometrial hyperplasia with atypia or early endometrial adenocarcinoma: a meta-analysis and systematic review of the literature. Gynecol. Oncol. 2012; 125: 263.

11. Chao A. S., Chao A., Wang C. J., et al. Obstetric outcomes of pregnancy after conservative treatment of endometrial cancer: case series and literature review. Taiwan J. Obstet. Gynecol. 2011; 50: 62-66.

12. Magnowska M., Nowak-Markwitz E., Frankowski A., Rzeszutko W., Spaczyński M. Successful pregnancy after conservative management of early stage endometrial carcinoma in a young nulliparous woman. Arch Med Sci. 2015; 11 (1): 237-239. DOI: 10.5114/aoms.2013.36183. Epub 2015 Mar 14. PMID: 25861314; PMCID: PMC4379357.

13. Chae S. H., Shim S., Lee S. J., et al Pregnancy and oncologic outcomes after fertility-sparing management for early stage endometrioid endometrial cancerInternational Journal of Gynecologic Cancer. 2019; 29: 77-85.