Ya‐Ting Hsu

Long‐term outcomes of fertility‐sparing treatment in endometrial carcinoma and endometrial intraepithelial neoplasia: Recurrence risk factors over a 9‐year follow‐up

AbstractIntroductionFertility‐sparing treatments using oral progestins have demonstrated promising oncologic outcomes for endometrial intraepithelial neoplasia and early‐stage endometrial cancer. However, the high recurrence rate remains a major concern, and the literature on long‐term follow‐up outcomes is limited. This study aimed to identify recurrence risk factors by analyzing clinicopathological and molecular profiles in a cohort with a median follow‐up of 9 years.Material and MethodsThis retrospective study included patients under 45 years of age who were diagnosed with endometrial intraepithelial neoplasia or endometrial cancer and received fertility‐sparing treatments at our center between 2010 and 2021. Patients who achieved complete responses were categorized according to recurrence status. Demographic, clinical, and molecular data were compared between groups. The primary endpoint was to identify risk factors for recurrence; secondary endpoints assessed obstetric and oncologic outcomes in patients with relapse.ResultsOut of 40 patients, 8 underwent hysterectomy within 1.5 years, while 32 responded to treatment and continued follow‐up. The recurrence and non‐recurrence groups contained 20 and 12 patients, respectively, with a median follow‐up of 107.5 months (range, 35–175 months). Multivariate analysis showed that a family history of cancer (HR = 2.597, p = 0.039) and treatment with megestrol acetate as the initial therapy (HR = 3.130, p = 0.021) were independent risk factors for shorter time to recurrence. Although mismatch repair deficiency was positively correlated with recurrence, the association did not reach statistical significance (p = 0.057). Four out of 24 patients were upstaged after hysterectomy, and all were in the recurrence group. Nine patients (22.5%) achieved pregnancy, with three successfully conceiving after achieving complete response following retreatment.ConclusionsIn patients with long‐term follow‐up after fertility‐sparing treatment, a family history of cancer and initial treatment with megestrol acetate were significantly associated with recurrence.

Maternal survival of patients with pregnancy‐associated cancers in Taiwan – A national population‐based study

AbstractPregnancy‐associated cancer (PAC), defined as cancers diagnosed during pregnancy or the first year after delivery, affects one to two in every 1000 pregnancies. Although PAC is expected to be a growing issue, information about PAC in the Asian population is still scarce. Women with cancer diagnosed at the age of 16–49 years between 2001 and 2015 were selected from the Taiwan Cancer Registry and linked with the National Birth Reporting Database to identify PAC patients. We compared the overall survival of patients with PAC to patients without pregnancy. Among 126,646 female cancer patients of childbearing age, 512 were diagnosed during pregnancy, and 2151 during the first postpartum year. Breast cancer was the most common PAC (N = 755, 28%). Compared with patients without pregnancy in the control group, patients with cancers diagnosed during pregnancy and the first postpartum year generally had more advanced stages (odds ratio 1.35 and 1.36, 95% confidence interval [CI] 1.02–1.77 and 1.18–1.57, respectively). For all cancer types combined and controlled for the stage, age, and year of diagnosis, patients with PAC had similar overall survival with those in the control group, with a hazard ratio (HR) of 1.07 (95% CI 0.80–1.41) for the pregnancy group and HR 1.02 (95% CI 0.88–1.18) for the postpartum group. The diagnosis of breast cancer during the first postpartum year was linked with shorter survival (HR 1.34, 95% CI 1.05–1.72). In contrast, patients with postpartum lymphoma (HR 0.11, 95% CI 0.02–0.79) and cervical cancer (HR 0.40, 95% CI 0.20–0.82) had better prognosis. In general, the diagnosis of cancer during pregnancy or the first postpartum year does not affect the survival of patients with most cancer types. Exceptions include the worse prognosis of postpartum breast cancer and the better outcome of postpartum lymphoma and cervical cancer.