子宫内膜癌保留生育治疗后的冻融胚胎移植结局
该回顾性倾向评分匹配队列研究纳入2020至2024年126对匹配患者，比较子宫内膜癌保留生育治疗后完全缓解者与不孕对照的冻融胚胎移植结局。研究组首次移植临床妊娠率37.3%对61.1%、活产率23.8%对47.6%均显著更低，累计活产率亦显著降低（HR 0.60），提示组织学缓解不等于内膜功能恢复。
要点
- 子宫内膜癌保留生育治疗后首次冻融移植临床妊娠率与活产率显著低于对照。
- 研究组需更长雌激素准备时间，转化日内膜更薄且累计活产率显著降低。
- 完全缓解时间超过6个月与临床妊娠几率降低独立相关。
核心结论
- 子宫内膜癌保留生育治疗后的组织学缓解不等于子宫内膜功能恢复，表现为内膜发育受损和活产率显著降低。
- 结果提示应将子宫内膜保护纳入初始肿瘤治疗。
研究设计与样本
- 回顾性倾向评分匹配队列研究，于2020年1月1日至2024年12月31日在三级转诊医院开展。
- IA期1级子宫内膜癌或子宫内膜上皮内瘤变达完全缓解者，按年龄、BMI和不孕类型1：1匹配输卵管或男性因素不孕对照。
- 共分析126对匹配患者（252例），均采用人工周期准备内膜后行囊胚移植。
主要发现
- 首次冻融胚胎移植周期，研究组临床妊娠率47/126（37.3%）对77/126（61.1%），P<.001。
- 首次冻融胚胎移植周期，研究组活产率30/126（23.8%）对60/126（47.6%），P<.001。
- 校正混杂因素后，有子宫内膜肿瘤性病变史者生殖结局的odds显著低于对照。
- 研究组雌激素准备时间中位14天对12天（P<.001），血清雌二醇更高但转化日内膜显著更薄（P<.001）。
- Kaplan-Meier分析显示研究组累计活产率显著更低（HR 0.60，95%CI 0.40-0.89，P=.012）；完全缓解时间超过6个月与临床妊娠odds降低独立相关（OR 0.50，95%CI 0.30-0.85，P=.011）。
临床怎么用
- 对子宫内膜癌保留生育治疗后妊娠者，应预期内膜反应受损并个体化延长雌激素准备。
- 移植前需充分评估内膜厚度与形态，并告知活产率可能显著低于普通不孕人群。
- 完全缓解时间超过6个月者临床妊娠几率更低，咨询时应予以关注。
局限性
- 回顾性设计，样本来自单一三级转诊医院，可能存在选择偏倚。
- 匹配仅基于年龄、BMI和不孕类型，其他混杂因素可能残留。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
OBJECTIVE: To evaluate the effect of a history of endometrial neoplastic lesions and subsequent fertility-sparing treatment on reproductive outcomes and endometrial response in frozen-thawed embryo transfer cycles. METHODS: This retrospective, propensity score-matched cohort study was conducted at a tertiary referral hospital between January 1, 2020, and December 31, 2024. Patients who achieved complete remission of stage IA, grade 1 endometrial carcinoma or endometrial intraepithelial neoplasia were matched 1:1 to patients with infertility in a control group (tubal or male factor) on the basis of age, body mass index (BMI), and infertility type. A total of 126 matched pairs (252 patients) were analyzed. All participants underwent artificial cycles for endometrial preparation followed by blastocyst transfer. Primary outcome measures included the clinical pregnancy rate and live-birth rate in the first frozen-thawed embryo transfer cycle and the cumulative live-birth rate across successive cycles. RESULTS: In the first frozen-thawed embryo transfer cycle, the study group exhibited significantly lower rates of clinical pregnancy (47/126 [37.3%] vs 77/126 [61.1%], P <.001) and live birth (30/126 [23.8%] vs 60/126 [47.6%], P <.001) compared with the control group. After adjustment for confounders, patients with a history of endometrial neoplastic lesions had significantly lower odds of reproductive outcomes than patients in the control group. Patients with a history of endometrial neoplastic lesions required longer estrogen preparation (median 14 days vs 12 days, P <.001) and achieved higher serum estradiol levels yet demonstrated significantly thinner endometrium at conversion ( P <.001). Kaplan-Meier analysis showed a significantly lower cumulative live-birth rate in the study group (hazard ratio 0.60, 95% CI, 0.40-0.89, P =.012). Within the study cohort, a time to complete remission exceeding 6 months was independently associated with reduced odds of clinical pregnancy (odds ratio 0.50, 95% CI, 0.30-0.85, P =.011). CONCLUSION: Histologic remission after fertility-sparing treatment for endometrial carcinoma does not equate to functional endometrial recovery, as evidenced by impaired endometrial development and significantly compromised live-birth rates. These findings highlight the necessity of incorporating endometrial protection into initial oncologic treatments.
引用
- Cheng X, Zhang D, Gan J, et al. Frozen-Thawed Embryo Transfer Outcomes After Fertility-Sparing Treatment for Endometrial Carcinoma. Obstet Gynecol. 2026. PMID: 42208068. doi:10.1097/AOG.0000000000006329
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。