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

Citation neighborhood (2-hop)

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

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