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    Weight loss during intrauterine progestin treatment for obesity-associated atypical hyperplasia and early stage cancer of the endometrium

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    Authors
    Barr, C. E.
    Ryan, N. A.
    Derbyshire, A. E.
    Wan, Y. L.
    MacKintosh, M. L.
    McVey, R. J.
    Bolton, J.
    Fitzgerald, C.
    Awad, D.
    Slade, Richard J
    Syed, A. A.
    Ammori, B. J
    Crosbie, Emma J
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    Affiliation
    Manchester University NHS Foundation Trust
    Issue Date
    2021
    
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    Abstract
    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 non-randomized study of women with obesity and atypical hyperplasia or low-grade stage 1a endometrial cancer undergoing progestin treatment. Women with a BMI{greater than or equal to}35kg/m2 were offered bariatric surgery; those who declined and those with BMI 30-34.9kg/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 >10% total body weight loss on progestin treatment response at 12 months. 71 women [median age 58years-(IQR 35-65); mean BMI 48kg/m2-(SD 9.3)] completed the study. 23 women (32%) had bariatric surgery, on average 5 months (IQR 3-8) after progestin treatment commenced. Weight change during progestin treatment was -33.4kg (95%CI -42.1, -24.7) and -4.6kg (95%CI -7.8, -1.4) in women receiving bariatric surgery and low-calorie diet, respectively (p<0.001). 43 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 >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.
    Citation
    Barr CE, Ryan NA, Derbyshire AE, Wan YL, MacKintosh ML, McVey RJ, et al. Weight loss during intrauterine progestin treatment for obesity-associated atypical hyperplasia and early stage cancer of the endometrium. Cancer Prev Res. 2021 Aug 4;canprevres.CAPR-21-0229-E.2021.
    Journal
    Cancer Prevention Research
    URI
    http://hdl.handle.net/10541/624505
    DOI
    10.1158/1940-6207.Capr-21-0229
    PubMed ID
    34348914
    Additional Links
    https://dx.doi.org/10.1158/1940-6207.Capr-21-0229
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1158/1940-6207.Capr-21-0229
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