Levonorgestre-lintrauterine system(LNG-IUS) plus Metformin compared with Megestrol Acetate (MA)plus Metformin as fertility-sparing treatment in patients with atypical endometrial hyperplasia and well differentiated endometrial cancer:a single-center retrospective study

Background The prevalence of early-stage endometrial cancer who have not given birth has risen signiffcantly in recent years.This study aimed to investigate the efficacy of Levonorgestre-lintrauterine system(LNG-IUS) combined with high-dose progest and metformin in fertility-preserving treatment patients of early-stage endometrial cancer and atypical endometrial hyperplasia. Methods A retrospective analysis was conducted on clinical data of 82 patients (15 cases of early-stage endometrial cancer and 67 cases of atypical endometrial hyperplasia), who required fertility-preserving treatment,at Shenyang Women and Children′s Hospital, from January 1, 2015, to December 30,2024.Patients were divided into the test group(32 cases treated with LNG-IUS and metformin) and the control group(50 cases treated with high-dose progestin and metformin). Regularly review endometrial pathology after surgery and analyze the efficacy of both groups. Results There was no statistically significant difference in general clinical data between the two groups; The test group had a higher complete remission rate (84.375%, P = 0.005), shorter complete remission time(5.333 ± 3.150months,P = 0.046), lower recurrence rate after remission(7.407%,P = 0.037),and higher pregnancy rate after remission(51.852%,P < 0.001).Meanwhile, stepwise regression analysis revealed that the treatment plan、 BMI ≥ 30Kg/m ² 、pathological type and suffering from PCOS are independent risk factors for complete remission in patients (P < 0.01). Treatment plan BMI ≥ 30Kg/m ² 、suffering from insulin resistance or diabetes,the time of complete remission are independent risk factors for relapse after complete remission(P < 0.01).Treatment plan、BMI ≥ 30Kg/m ² 、complete remission time are independent risk factors for complete remission pregnancy(P < 0.01). Conclusion The combination of LNG-IUS and Metformin has a more satisfactory therapeutic effect and pregnancy outcomes compared to the combination of high-dose progest and Metformin, that is safe and highly effective.