关键词: 子宫内膜非典型增生, 子宫内膜癌, 保留生育功能, 复发, 再治疗

Abstract:

Although fertility-preserving treatment strategies have demonstrated significant clinical efficacy in patients with early-stage endometrial cancer （EC） and atypical endometrial hyperplasia （AEH）， some patients who experience recurrence still express a strong desire for fertility and request conservative retreatment. This poses new challenges for clinical management. This article reviews the latest research advances in retreatment for recurrent patients and synthesizes findings from previous studies to draw the following conclusions. First， before formulating a retreatment plan， it is crucial to comprehensively evaluate key factors such as tumor characteristics， fertility intentions， and overall health status of the patient. These factors collectively determine the feasibility and appropriateness of an individualized retreatment strategy. Second， studies have shown that retreatment options for AEH/EC are diverse， with high-dose oral progestin remaining the primary approach. Combining progestin with metformin， GnRH-a， and hysteroscopic resection can enhance treatment outcomes. Individualized treatment plans should be tailored to the specific conditions of each patient. Based on literature analysis， the complete remission （CR） rate of retreatment ranges from 81.1% to 88.6%， with a pregnancy rate of 26.5% ? 50.0% and a live birth rate of 14.3% ? 29.0%. However， the recurrence rate remains high at 24.5% ? 45.5%， significantly higher than that of initial treatment. This indicates that while retreatment has achieved some success in disease control and fertility preservation， the risk of recurrence still requires significant attention. Therefore， a strict monitoring and follow-up system must be established during retreatment. Additionally， studies have identified factors associated with a higher risk of recurrence， including age over 35， overweight or obesity， polycystic ovarian syndrome， metabolic syndrome， high pathological grade， and advanced clinical stage. On the other hand， pregnancy following CR， weight loss， and maintenance therapy serve as protective factors against disease recurrence. Patients are encouraged to actively engage in weight management during treatment and consider initiating assisted reproductive technology promptly after achieving CR to optimize pregnancy outcomes while minimizing the risk of recurrence. Future research should prioritize investigating precision treatment strategies informed by molecular classification and identifying predictive biomarkers， thereby enabling the development of more personalized and precise treatment plans tailored to individual patients.

Key words: atypical endometrial hyperplasia, endometrial cancer, fertility preservation, recurrence, retreatment