Adjuvant therapy in conservative surgery for adenomyosis

Chao X, Xiaopei Chao, Song X, Xiaochen Song, Huanwen Wu, You Y, Yan You, Li L, Lei Li, Jinghe Lang
International Journal of Gynecology & Obstetrics · 2020 · vol. 154(1) , pp. 119–126 · doi:10.1002/ijgo.13573 · PMID:33368241 · W3116122762
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Perioperative adjuvant therapy with GnRHa and/or LNG-IUS significantly reduced adenomyosis recurrence after uterus-sparing surgery, with older age being a risk factor.

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Abstract

OBJECTIVE: To investigate the significance of perioperative levonorgestrel-releasing intrauterine system (LNG-IUS) and/or gonadotropin-releasing hormone agonists (GnRHa) as adjuvant therapy in preventing recurrences or progression of diseases. METHODS: Medical records were collected from patients diagnosed with adenomyosis who underwent uterus-sparing surgeries from March 1, 2012 to December 31, 2018. The associations of perioperative adjuvant therapy with recurrence of disease and symptoms were analyzed with the Kaplan-Meier method and proportional hazards models with hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: A total of 322 eligible patients were included, of whom 173 (58.1%) received perioperative adjuvant therapy. Perioperative adjuvant therapy (HR 0.44, 95% CI 0.22-0.91, P = 0.022) and perioperative GnRHa therapy (HR 0.48, 95% CI 0.24-0.99, P = 0.042) significantly reduced disease recurrence. No patient using perioperative LNG-IUS therapy experienced recurrence. In the multivariate analysis, increased age (>35 years at surgery) was the only risk factor for disease recurrence (HR 2.35, 95% CI 1.01-5.45, P = 0.047). CONCLUSION: Perioperative adjuvant therapy with GnRHa and/or the LNG-IUS can significantly reduce disease recurrence or progression for adenomyosis patients undergoing uterus-sparing surgery. Older patients are more likely to experience disease recurrence.

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Condition tags

adenomyosis

MeSH descriptors

Adenomyosis Adenomyosis Intrauterine Devices, Medicated Adenomyosis Adult Combined Modality Therapy Delayed-Action Preparations Female Humans Intrauterine Devices, Medicated Levonorgestrel Levonorgestrel Middle Aged

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