Intrauterine progestin is a treatment option for women with atypical hyperplasia or low-risk endometrial cancer who wish to preserve their fertility, or whose poor surgical fitness precludes safe hysterectomy. We hypothesized that in such women with obesity, weight loss during progestin treatment may improve oncological outcomes. We conducted a prospective nonrandomized study of women with obesity and atypical hyperplasia or low-grade stage 1a endometrial cancer undergoing progestin treatment. Women with a body mass index (BMI) ≥ 35 kg/m2 were offered bariatric surgery; those who declined and those with a BMI of 30 to 34.9 kg/m2 were encouraged to lose weight by low-calorie diet. We assessed uptake of bariatric surgery; weight lost during progestin treatment; and the impact of more than 10% total body weight loss on progestin treatment response at 12 months. 71 women [median age 58 years (interquartile range; IQR 35–65); mean BMI 48 kg/m2 (SD 9.3)] completed the study. Twenty-three women (32%) had bariatric surgery, on average 5 months (IQR 3–8) after progestin treatment commenced. Weight change during progestin treatment was −33.4 kg [95% confidence interval (CI) −42.1, −24.7] and −4.6 kg (95% CI −7.8, −1.4) in women receiving bariatric surgery and low-calorie diet, respectively ( P < 0.001). Forty-three women (61%) responded to progestin, while 23 (32%) showed stabilized and 5 (7%) progressive disease. Response at 12 months was not predicted by age or baseline BMI, but women who lost more than 10% of their total body weight were more likely to respond to progestin than those who did not (adjusted odds ratio 3.95; 95% CI 1.3, 12.5; P = 0.02). Thus weight loss may improve oncological outcomes in women with obesity-associated endometrial neoplastic abnormalities treated with progestin. Prevention Relevance: This study found that weight loss improves response rates in women with obesity and atypical hyperplasia or low-risk endometrial cancer undergoing conservative management with intrauterine progestin. Given the additional benefits of weight loss for fertility, cardiovascular health and quality of life, future research should focus on how best to accomplish it.

中文翻译：

---

宫内孕激素治疗肥胖相关的不典型增生和早期子宫内膜癌期间的体重减轻


对于患有不典型增生或低风险子宫内膜癌、希望保留生育能力或因手术适合性不佳而无法进行安全子宫切除术的女性，宫内孕激素是一种治疗选择。我们假设，对于此类肥胖女性，在孕激素治疗期间减轻体重可能会改善肿瘤结果。我们对患有肥胖症和不典型增生或低度 1a 期子宫内膜癌且接受孕激素治疗的女性进行了一项前瞻性非随机研究。体重指数 (BMI) ≥ 35 kg/m2 的女性接受减肥手术；那些体重下降的人和BMI在30至34.9公斤/平方米的人被鼓励通过低热量饮食减肥。我们评估了减肥手术的接受情况；孕激素治疗期间体重减轻；以及 12 个月时总体体重减轻 10% 以上对孕激素治疗反应的影响。 71 名女性 [中位年龄 58 岁（四分位距；IQR 35–65）；平均 BMI 48 kg/m2 (SD 9.3)] 完成了研究。 23 名女性 (32%) 在开始孕激素治疗后平均 5 个月 (IQR 3-8) 接受了减肥手术。接受减肥手术和低热量饮食的女性在孕激素治疗期间的体重变化分别为-33.4 kg [95%置信区间(CI) -42.1, -24.7]和-4.6 kg (95% CI -7.8, -1.4)。 P< 0.001）。 43 名女性 (61%) 对孕激素有反应，23 名女性 (32%) 病情稳定，5 名女性 (7%) 病情进展。 12 个月时的反应不是通过年龄或基线 BMI 来预测的，但体重减轻超过 10% 的女性比没有减轻体重的女性更有可能对孕激素产生反应（调整比值比 3.95；95% CI 1.3, 12.5） P = 0.02）。 因此，减肥可能会改善接受孕激素治疗的患有肥胖相关子宫内膜肿瘤异常的女性的肿瘤学结果。预防相关性：这项研究发现，减肥可以提高患有肥胖症和不典型增生或低风险子宫内膜癌的女性接受宫内孕激素保守治疗的反应率。鉴于减肥对生育能力、心血管健康和生活质量的额外好处，未来的研究应该集中在如何最好地实现这一目标。