GnRHa/AI or progestin fertility-sparing treatment improves QoL in EC/AEH patients with shorter treatment durations

For women diagnosed with early-stage endometrial cancer (EC) or atypical endometrial hyperplasia (AEH) who desire to preserve fertility, conservative, fertility-sparing treatments are crucial. Standard approaches often involve high-dose progestins, sometimes combined with other agents like gonadotropin-releasing hormone agonists (GnRHa) and aromatase inhibitors (AI). While these treatments aim for disease remission, their impact on a patient's quality of life (QoL) during the treatment period, which can be prolonged, is not always well-understood. This study addresses the gap by investigating QoL and its influencing factors in patients undergoing these specific fertility-sparing regimens.

Researchers enrolled a total of 134 patients with early-stage endometrial cancer (EC) or atypical endometrial hyperplasia (AEH) undergoing fertility-sparing treatment. Patients received either gonadotropin-releasing hormone agonist (GnRHa) combined with aromatase inhibitors or high-dose oral progestins. Diagnostic curettage or hysteroscopy was performed every 3 months to assess complete response (CR). QoL was quantitatively assessed using the Functional Assessment of Cancer Therapy-General (FACT-G) version 4 questionnaire, administered at baseline and every 3 months during treatment until CR. Patients were categorized into groups based on time to CR: 3-month (n=79), 6-month (n=40), and ≥9-month (n=15) groups. Multivariate linear regression analyzed QoL influencing factors.

Among the 134 patients, 61 (45.5%) had atypical endometrial hyperplasia (AEH) and 73 (54.5%) had endometrial cancer (EC). Treatment distribution showed 71 patients (53.0%) received GnRHa combined with aromatase inhibitors, while 63 (47.0%) received high-dose oral progestins. QoL assessment using FACT-G scores revealed a gradual increase from baseline in both the 3-month and 6-month treatment groups, indicating an improvement in QoL as treatment progressed. Conversely, the median FACT-G scores in the ≥9-month group consistently remained below 80 throughout the treatment period, suggesting a relatively lower QoL for those requiring longer treatment durations. However, despite these trends, there was no statistically significant difference in FACT-G scores observed at the point of complete response (CR) among the 3-month, 6-month, and ≥9-month groups.

Median FACT-G scores at CR were 82.0, 83.0, and 76.5, respectively, with a statistical comparison yielding H=1.575, P=0.455.