Abstract
Introduction
We aimed to assess the safety of continuous uterus‐preserving treatment among patients with endometrial cancer (EC) and atypical endometrial hyperplasia (AEH) who gave birth after progestin‐based fertility‐sparing treatment (FST).
Material and Methods
From January 2005 to June 2020, we conducted a retrospective cohort study at Peking University People's Hospital, China, comprising 212 patients with EC or AEH who underwent FST. The participants were categorized into two groups based on the reproductive outcome of live birth. Risk factors were analyzed for disease recurrence in the entire cohort, and additional analysis was conducted on postpartum recurrence specifically in the live birth group.
Results
Of 212 eligible patients, 73 had a live birth, and 139 did not have a live birth after FST. Multivariable Cox analysis showed that live birth significantly reduced the risk of disease recurrence (HR 0.326, p = 0.011), while insulin resistance was identified as an adverse factor (HR 3.216, p = 0.014). Except for two patients who underwent hysterectomy, among 71 patients undergoing uterus preservation after live birth, five (7%) patients experienced disease relapse (two EC and three AEH) after a median follow‐up of 26 (11, 47.5) months. Four out of these five patients with recurrence achieved a complete response after a second round of FST. Eight other patients (11.3%) experienced hyperplasia without atypical (EH) after live birth. Potential risk factors for postpartum recurrence of EC/AEH included irregular menstruation (80% vs. 39%; p = 0.153), abnormal ultrasonographic findings (60% vs. 18.6%; p = 0.065), and increased endometrial thickness (0.82 cm vs. 0.55 cm; p = 0.017). While postpartum maintenance therapy was identified as a protective factor against recurrence (0% vs. 62.5%; p = 0.012). Notably, patients with postpartum recurrence may achieve a complete response with repeat FST.
Conclusions
Although live birth was associated with improved recurrence‐free survival in patients with EC or AEH receiving FST, postpartum recurrence remains a concern. Irregular menstruation and abnormal ultrasound findings were identified as key risk factors for recurrence, while maintenance therapy exhibited a protective effect. These findings highlight the need for vigilant postpartum monitoring in this population.
Keywords: endometrial neoplasms, fertility preservation, live birth, postpartum period, recurrence
Achieving live birth following fertility‐sparing treatment is associated with improved recurrence‐free survival among patients with endometrial cancer/atypical endometrial hyperplasia.
Abbreviations
- AEH
atypical endometrial hyperplasia
- CR
complete response
- EC
endometrial cancer
- EH
hyperplasia without atypical
- FST
fertility‐sparing treatment
- LNG‐IUS
levonorgestrel‐releasing intrauterine system
- MA
megestrol acetate
- MPA
medroxyprogesterone acetate
- RFS
recurrence‐free survival
Key message.
Although live birth after remission significantly reduced the risk of recurrence, postpartum endometrial cancer/atypical endometrial hyperplasia remains a concern. Irregular menstruation and abnormal ultrasound findings were key risk factors, while maintenance therapy was protective. Notably, patients with postpartum recurrence may achieve a complete response with repeat fertility‐sparing treatment.
1. INTRODUCTION
Endometrial cancer (EC) is a leading gynecological cancer in developed countries. Although EC is most commonly diagnosed in postmenopausal women, increasing rates of obesity and other lifestyle changes have contributed to the increased incidence of EC among younger women. Approximately 20% of cases are diagnosed before menopause. 1 Because of delayed childbearing, approximately 70% of reproductive‐age women with EC do not complete childbearing and may desire fertility preservation. 2 , 3 Along with the implementation of China's two‐child and three‐child policies, an increasing number of patients with EC express a strong desire to preserve fertility. 4 , 5 Thus, fertility‐sparing treatment (FST) is promising in young patients with EC or atypical endometrial hyperplasia (AEH). Conservative treatment options include oral high‐dose progestins, such as medroxyprogesterone acetate (MPA), megestrol acetate (MA), and levonorgestrel‐releasing intrauterine system (LNG‐IUS). 6 , 7 The remission rate and pregnancy rate for progestin therapy are 70.7%–88.6% and 21.3%–32.4% for strictly selected patients, respectively. 8 , 9 , 10 Recent studies have primarily focused on pregnancy and obstetric outcomes in these patients, 11 suggesting increased rates of labor induction, cesarean section, and postpartum hemorrhage. 12
According to the ESGO/ESHRE/ESGE, NCCN guidelines, and Chinese expert consensus, hysterectomy is recommended after delivery in patients with AEH or EC due to concerns about tumor recurrence. 13 , 14 , 15 However, evidence regarding postpartum recurrence risk remains limited, and no studies have systematically reported such outcomes to date. Further studies on the postpartum course of patients who achieve live births after FST are critical to evaluate the safety of long‐term uterus preservation. Peking University People's Hospital (PKUPH) has been offering FST to patients with EC/AEH since 2005. 16 , 17 These patients have been systematically monitored for treatment response, pregnancy outcomes, and long‐term prognosis. We conducted this retrospective cohort study to evaluate the effect of live birth on long‐term oncological outcomes in patients with EC/AEH undergoing FST, particularly those who retained their uterus after childbirth.
This study aimed to analyze the long‐term postpartum outcomes of patients with AEH and EC who underwent FST and achieved successful live births at our institution over a 15‐year period.
2. MATERIAL AND METHODS
2.1. Study population
Patients with EC or AEH who underwent FST at the PKUPH between January 2005 and June 2020 were retrospectively included, and their clinical, histopathological, and follow‐up data were obtained. The inclusion criteria were as follows: (1) age ≤40 years; (2) a strong desire to preserve fertility; (3) International Federation of Gynecology and Obstetrics 2009 IA grade 1–2 EC with a lesion confined in the endometrium or AEH; (4) no evidence of extrauterine or distant metastasis in enhanced MRI of patients with EC; and (5) no contraindications for conservative treatment. All patients were thoroughly counseled about the advantages and risks of FST. Only those who voluntarily opted for this approach after counseling and provided written informed consent were included in this study. The patients were divided into two groups based on the success of childbearing.
2.2. Fertility‐sparing treatment
Patients were treated with either MPA 250–500 mg/day, MA 160 mg/day, or LNG‐IUS plus gonadotropin‐releasing hormone agonist (GnRHa) 3.75 mg every 28 days as FST. Patients underwent hysteroscopic endometrial biopsy every 3 months to assess the response to treatment. A complete response (CR) was defined as the absence of hyperplasia or carcinoma in pathological examination. After CR, the patients were monitored for recurrence every 3–6 months. Recurrence was defined as a pathologically proven EC or AEH. Pathological results showing endometrial hyperplasia without atypia were considered endometrial hyperplasia (EH), rather than recurrences.
Patients with CR were encouraged to conceive with or without active assisted reproduction technology (ART). Maintenance treatment, including low‐dose cyclic progestin, LNG‐IUS, or oral contraceptives, was administered for patients with CR but without a plan for close pregnancy to prevent recurrence.
The time interval to achieve CR was calculated from the diagnosis to the first negative biopsy. The time interval to pregnancy was calculated from the first CR to the time of pregnancy confirmation. The time interval to recurrence or hyperplasia was calculated from the first CR to pathologically confirmed recurrence of EC/AEH or EH.
2.3. Follow‐up after CR and childbearing
After CR or childbearing, the patients were followed every 3–6 months. The patients were monitored for regular menstruation and an ultrasound every 3 months. Hysteroscopic biopsy was conducted every 6 months or when there were suspicious endometrial lesions. Patients underwent hysterectomy after delivery; however, maintenance treatment was suggested if they chose not to undergo a postpartum hysterectomy. All patients were followed until October 31, 2024.
2.4. Statistical analysis
We first excluded patients with missing important follow‐up data, including 10 cases transferred to other hospitals and 16 cases with treatment length <3 months (Figure 1). To ensure the robustness of data, we implemented a comprehensive follow‐up protocol involving regular hospital visits supplemented by telephone interviews. We also maintained rigorous long‐term surveillance to minimize data loss. For the remaining missing data points, we employed multivariate multiple imputation using chained equations (MICE). 18 All data are presented descriptively as medians (first and fourth quartiles), mean ± standard deviation, or proportions. Two groups were compared using the Student's t‐test or the Mann–Whitney U test. Frequency distributions were compared using the χ 2 test, except for when the expected frequency was <5, where Fisher's exact test was employed. Recurrence‐free survival (RFS) was determined using Kaplan–Meier analysis and compared between the live birth and non‐live birth groups using the log‐rank test. Univariate and multivariate Cox regression analyses were conducted to identify risk factors for disease recurrence after achieving CR. In two‐sided tests, p‐values <0.05 were deemed significant. All statistical analyses were conducted using SPSS (version 20.0 for Mac; IBM Corp., Armonk, NY) and R software.
FIGURE 1.
Flowchart of enrollment process, including women who underwent fertility‐sparing treatment of EC and AEH. AEH, atypical endometrial hyperplasia; CR, complete response; EC, endometrial cancer; NR, no response; PR, partial response.
3. RESULTS
3.1. General characteristics of patients with EC/AEH with or without childbearing
The flowchart of the patient inclusion process is presented in Figure 1. In total, 212 patients, including 102 patients with EC and 110 with AEH who underwent the FST, were included in this study. Among them, 193 received the MPA/MA regimen, while 19 were treated with the GnRHa plus LNG‐IUS regimen. Seventy‐three had a successful childbirth and 139 did not have a successful childbirth. General information about the two groups is shown in Table S1. Patients in the childbearing group were younger (30.6 vs. 33.1 years, p < 0.001) and showed a lower BMI (26.2 vs. 27.8, p = 0.02), a lower rate of insulin resistance (45.2% vs. 59%, p = 0.056), and a significantly shorter treatment time to CR (5 vs. 9 months, p ≤ 0.001) compared to those in the non‐childbearing group. Other variables showed no significant differences between the two groups (Table S1).
3.2. Follow‐up outcomes in patients with or without childbearing
The recurrence rate was 13.7% (10/73) in the childbearing group and 25.7% (28/109) in the non‐childbearing group (p = 0.051). Kaplan–Meier survival analysis showed that childbearing is a protective factor against disease recurrence (p = 0.002) (Figure S1). Subgroup analyses were conducted based on pathological type (EC vs. AEH) and age (<35 vs. ≥35 years old) (Figure S2). Live birth exhibited significant prognostic benefits, particularly in the EC subgroup (p = 0.0062) and the <35 years subgroup (p < 0.001), while the benefits were less pronounced in AEH and ≥35 years subgroups. Univariable and multivariable Cox analysis were conducted to identify the risk factors of disease recurrence (Figure 2). Univariable results showed that live birth (p = 0.002), insulin resistance (p = 0.022), and time interval to CR (p = 0.006) were associated with disease recurrence (Figure 2). After adjusting for age, BMI, pathology, and other comorbidities including PCOS, DM, and IR, the multivariable analysis showed that live birth is an independent protective factor against disease recurrence (HR = 0.326, p = 0.011). Among patients with insulin resistance, recurrence risk was more than three times higher (HR = 3.216, p = 0.014) (Figure 2).
FIGURE 2.
Univariate and multivariate Cox analysis of risk factors of disease recurrence. BMI, body mass index; CR, complete response; DM, diabetes mellitus; IR, insulin resistance; PCOS, polycystic ovarian syndrome.
3.3. Treatment and reproductive outcomes of childbearing patients
The median treatment time to achieve CR was 5 months (3, 9 months) among 73 childbearing patients (Table S1). The treatment regimens included oral MPA or MA for 68 patients and LNG‐IUS plus GnRHa for five patients. All 73 patients became pregnant and delivered at full term after the FST. The reproductive outcomes are shown in Table S2. Only two patients underwent hysterectomy, both conducted concurrently with cesarean section. The median interval to pregnancy was 9 months (3, 13.75 months). Seventeen (23.3%) pregnancies were achieved through natural conception, 3 (4.1%) through ovulation stimulation, and 49 (67.1%) through in vitro fertilization and embryo transfer. The median gestational age was 39 weeks (38, 40 weeks). Regarding complications of pregnancy, 20 (32.3%) patients suffered from abnormal glucose metabolism. Other major comorbidities included hypertension, postpartum hemorrhage, and incompetent internal cervical os (Table S2).
3.4. Postpartum follow‐up outcomes in childbearing patients
Although hysterectomy was suggested for patients who delivered, none of the 71 patients underwent hysterectomy for personal reasons. After a median follow‐up period of 26 (11, 47.5) months, only five (7.0%) patients experienced disease recurrence, including two with EC and three with AEH. In addition, another eight patients experienced EH (11.3%).
Analysis of risk factors for recurrence showed that patients with postpartum relapse had a significantly thicker endometrium (0.82 cm vs. 0.55 cm; p = 0.017) and a higher prevalence of abnormal ultrasound echogenicity (60% vs. 18.6%; p = 0.065) and irregular menstruation (80% vs. 39%; p = 0.153). Notably, patients had a lower recurrence rate after receiving postpartum maintenance therapy (0% vs. 62.5%; p = 0.012). The relapse group exhibited a trend toward a higher BMI (29.01 vs. 25.95; p = 0.226) and a longer time to achieve complete remission (10 vs. 5 months; p = 0.106). No other factors, including pathology, age, insulin resistance, gestational age, duration of lactation, or recurrence before pregnancy, were significantly associated with recurrence (Table 1). Separate analyses of risk factors of recurrence in the AEH and EC groups are summarized in Table S3. In addition, immunohistochemistry staining was reviewed for the initial diagnostic biopsies of these five patients. Results showed positive expression of both estrogen receptor, progesterone receptor, along with wild‐type p53 expression in all cases.
TABLE 1.
Characteristics of 71 EC/AEH patients with or without postpartum recurrence.
| Variables | Patients without postpartum recurrence (n = 66) | Patients with postpartum recurrence (n = 5) | p value |
|---|---|---|---|
| Pathology | |||
| AEH | 38 (57.6%) | 3 (60%) | 1.000 |
| EC | 28 (42.4%) | 2 (40%) | |
| Age at diagnosis (year) | 30.3 ± 3.6 | 31.4 ± 3.6 | 0.546 |
| BMI (kg/m2) | 25.95 ± 5.49 | 29.01 ± 3.43 | 0.226 |
| IR | |||
| Yes | 29 (43.9%) | 3 (60%) | 0.652 |
| No | 37 (56.1%) | 2 (40%) | |
| Treatment regimen | |||
| MPA/MA | 62 | 4 | 0.280 |
| GnRHa +LNG‐IUS | 4 | 1 | |
| Time interval to CR (months) | 5 (3, 9) | 10 (4, 19) | 0.106 |
| Time interval to pregnancy (months) | 7.5 (3, 15.25) | 4 (0.75, 29.75) | 0.381 |
| Conception method | |||
| Natural | 16 (25.8%) | 1 (20%) | 0.740 |
| Ovulation induction | 3 (4.8%) | 0 (0%) | |
| IVF‐ET | 43 (69.4%) | 4 (80%) | |
| Gestational age (weeks) | 39 (38, 40) | 39 (37.5, 40.5) | 0.728 |
| Duration of lactation (months) | 15 (10, 23) | 12 (3, 16.5) | 0.162 |
| Irregular Menstrual | |||
| Yes | 23 (39%) | 4 (80%) | 0.153 |
| No | 36 (61%) | 1 (20%) | |
| Endometrium thickness | 0.55 ± 0.27 | 0.82 ± 0.19 | 0.017 |
| Abnormal echo of ultrasound | |||
| No | 48 (81.4%) | 2 (40%) | 0.065 |
| Yes | 11 (18.6%) | 3 (60%) | |
| Maintenance treatment after birth | |||
| Yes | 30 (62.5%) | 0 (0) | 0.012 |
| No | 18 (37.5%) | 5 (100%) | |
| Recurrence before pregnancy | |||
| Yes | 5 (13.5%) | 1 (20%) | 0.557 |
| No | 32 (86.5%) | 4 (80%) | |
Abbreviations: AEH, atypical endometrial hyperplasia; AEH, atypical endometrial hyperplasia; BMI, body mass index; BMI, body mass index; CR, complete response; EC, endometrial cancer; EC, endometrial cancer; EH, endometrial hyperplasia without atypical; GnRHa, gonadotropin‐releasing hormone agonist; IR, insulin resistance; IVF‐ET, in vitro fertilization and embryo transfer; LNG‐IUS, levonorgestrel‐releasing intrauterine system; MA, megestrol acetate; MPA, medroxyprogesterone; PCOS, polycystic ovarian syndrome.
3.5. Treatment results in the postpartum recurrent group
Five patients revealed postpartum disease recurrence of EC/AEH, and their specific treatment data are presented in Figure 3. The median time from delivery to recurrence was 11 months (8, 18.5 months).
FIGURE 3.
Treatment process for the five patients who suffered from relapse after live birth delivery following FST.
Patient 1 (EC) experienced disease recurrence before live birth, and two remission periods were 11 and 18 months, respectively. She became pregnant 3 months after CR. Seventeen months after childbirth, pathological examination showed EC recurrence. She received another round of combined therapy of FST (MPA for 10 months, which then changed to GnRHa + LNG‐IUS for 7 months) and achieved CR again.
Patient 2 (AEH) became pregnant 13 months after the first CR. She did not experience recurrence of AEH until 33 months after childbirth. She received MA for 6 months and achieved CR again.
Patient 3 (AEH) became pregnant 10 months after the first CR. She did not experience recurrence until 21 months after childbirth. Next, she underwent hysterectomy and postoperative pathological examination showed AEH.
Patient 4 (EC) became pregnant 6 months after CR. She experienced AEH recurrence at 9 months after childbirth and achieved another CR after 4 months of treatment with MPA.
Patient 5 (AEH) became pregnant right after CR, experienced AEH recurrence 9 months after childbirth, and achieved CR after 4 months of treatment with MPA.
4. DISCUSSION
Our study achieved a postpartum recurrence risk of 7% for EC/AEH following FST and subsequent live birth. In this retrospective analysis of 71 patients undergoing uterus‐preserving management (median follow‐up: 26 months), disease recurrence was observed for 5 patients with EC/AEH. Key risk factors for postpartum recurrence included irregular menstruation and abnormal endometrial thickness or ultrasound findings, whereas maintenance therapy exhibited protective effects against recurrence. These findings highlight the importance of long‐term monitoring in patients with EC/AEH who opted for fertility preservation but completed childbearing.
Properly tailored follow‐up is necessary for patients with EC/AEH undergoing FST. The recurrence rate of EC/AEH after conservative treatment was reported to be 25.3%–38%. 19 , 20 Thus, a successful pregnancy may prevent recurrence. Long‐term follow‐up of 148 patients with EC after FST indicated that pregnancy (odds ratio, 0.25; 95% confidence interval, 0.11–0.56; p = 0.001) was significantly associated with a lower risk of recurrence. 21 A retrospective study of 68 patients evaluating pregnancy‐associated factors after FST showed a lower relapse rate in a pregnancy group than in a non‐pregnancy group (16.7% vs. 40.6%). 22 Our results also showed that childbearing patients had a longer RFS compared with non‐pregnant patients (47 vs. 15 months, p = 0.002). Subgroup analyses also indicated that childbearing significantly improves prognosis, especially in the EC subgroup (p = 0.0062) and young patients (p < 0.001). Due to the high level of progestin during pregnancy and very low levels of estrogen in the postpartum period, it is reasonable to assume that patients who complete childbirth and lactation are less likely to suffer from relapse. The recurrence rate was 37.2% in patients who did not give birth after treatment, but 11.3% among those who suffered from recurrence (p = 0.000001). 23 In our study, multiple Cox analyses showed that live birth may reduce the risk of disease recurrence (HR 0.326, 95%CI 0.137–0.775, p = 0.001).
Given that relapse after FST and live birth is less common in these patients, the identification of early signs of disease is crucial. Yin et al. also found that compared with controls, patients with EC/AEH who experienced recurrence after CR were more likely to suffer from irregular menstrual cycles (59.5% vs. 37.7%). 24 Thus, it is important to pay attention to abnormal symptoms after childbirth and to maintain regular menstruation. In this study, endometrial thickness also predicted the risk of postpartum recurrence (0.82 cm vs. 0.55 cm). Postpartum regular ultrasound examination is crucial to identify irregular signals of endometrial lesions. Strict surveillance with ultrasound every 3–6 months and clinical follow‐up of symptoms are recommended. Hysteroscopy and endometrial biopsy are recommended for abnormal vaginal bleeding or atypical ultrasound findings. 25
Maintenance therapy after CR is associated with reduced risk of disease recurrence. Our results showed that none of the five recurrent cases received maintenance treatment. A large‐scale study showed that maintenance therapy with LNG‐IUS can prolong disease‐free survival (DFS) after FST for EC/AEH (HR = 0.18). 23 Maintenance treatment includes low‐dose cyclic progestin or oral contraceptives which induce cyclic endometrial shedding, as well as the LNG‐IUS which provides sustained progestin release. Risk factors of EH, such as overweight and insulin resistance, still exist after childbearing, which may increase the risk of tumor recurrence in the future. However, our study showed that pathological features, age, BMI, IR, time interval to CR, time interval to pregnancy, or conception method were not significantly associated with postpartum recurrence. Since only a few cases of postpartum recurrence were included in our study, it is difficult to recognize the risk factors and predict long‐term recurrence. We will continue to extend the follow‐up of this cohort to obtain further outcomes. Nevertheless, patients should be fully assessed regarding the lifelong exposure to potential risks for endometrial lesions.
To our knowledge, this study represents the largest retrospective study to date evaluating postpartum recurrence rates in patients with EC/AEH undergoing FST. Our findings provide novel insights into the long‐term oncological risk factors associated with uterine preservation after successful childbearing. However, several limitations should be acknowledged. The retrospective design inherently carries potential bias. In addition, our sample size, while representing the largest reported to date, may limit the generalizability of our conclusions. To mitigate these limitations, we rigorously controlled for confounding variables such as BMI, age, medical comorbidities, and treatment duration through multivariate regression analysis. Our findings suggested that live birth remains an independent protective factor against disease recurrence, even after adjusting for these covariates. Additionally, the relatively limited number of recurrent events did not allow for comprehensive risk factor analysis. However, live birth itself is a protective factor, leading to fewer recurrences in this subgroup. Despite these limitations, our preliminary data underscore the need for careful long‐term surveillance in patients who undergo conservative management. The identification of irregular menstruation and abnormal ultrasound findings as potential risk factors, along with the protective effect of maintenance therapy, provides a clinically relevant guide for selecting patients and follow‐up strategies. Further large‐scale and prospective studies with extended follow‐up periods are needed to validate these findings and identify robust predictive factors for postpartum recurrence.
5. CONCLUSION
Our study demonstrated that achieving live birth following FST is associated with improved RFS among patients with EC/AEH. However, clinicians should remain vigilant about the persistent risk of postpartum disease recurrence, including both EC/AEH and EH. We identified irregular menstruation, abnormal ultrasound findings, and increased endometrial thickness as potential clinical indicators of postpartum recurrence. These findings highlight the need for careful risk stratification and long‐term surveillance among these patients.
AUTHOR CONTRIBUTIONS
Yiqin Wang, Rong Zhou, and Jianliu Wang conceptualized and designed this study. Yiqin Wang, Yuanyuan Liu, Linlin Bo, Zerui Xiao, Qun Lu, and Li Tian were responsible for data acquisition. Yiqin Wang contributed to the analysis and interpretation of data. Yiqin Wang drafted the manuscript. All authors read and approved the final version of this article.
FUNDING INFORMATION
This work was supported by the Major Projects of National Science and Technology (2025ZD0545900, 2025ZD0545901 and 2025ZD0545902), the Peking University Medicine Fund of Fostering Young Scholars' Scientific & Technological Innovation (Grant No. BMU2025YFJHPY024), and the National Natural Science Foundation of China (Grant No. 82501962).
CONFLICT OF INTEREST STATEMENT
The authors declare no conflicts of interest.
ETHICS STATEMENT
This study was conducted following the Declaration of Helsinki. The study protocol was approved by the Ethics Committee of the Peking University People's Hospital (IRB approval no. 2016PHB054‐01) on July 21, 2016. Written informed consent was obtained from all participants prior to their inclusion in the study.
Supporting information
Figure S1. Cumulative recurrence‐free survival (RFS) curves in the childbearing (N = 73) and non‐childbearing (N = 139) groups for patients with EC/AEH receiving FST. Patients with successful childbearing had longer RFS compared to patients in the non‐childbearing group (p = 0.002).
Figure S2. Subgroup analyses of RFS curves on histological type and age for patients undergoing FST, stratified by childbearing status. Live birth was associated with a significant improvement in RFS in the EC subgroup (p = 0.0062) (A), whereas only a marginal benefit was observed in the AEH subgroup (p = 0.092) (B). Live birth conferred a significant prognostic advantage in patients <35 years old (p < 0.001) (C), while no significant benefit was observed in the ≥35 years subgroup (p = 0.421) (D).
Table S1. Baseline characteristics of 212 patients in the childbearing and non‐childbearing groups.
Table S2. Reproductive outcomes of 73 childbearing patients.
Table S3. Characteristics of 41 AEH and 30 EC patients with or without postpartum recurrence.
ACKNOWLEDGMENTS
The authors sincerely appreciate the dedicated efforts of the nursing team in the Department of Obstetrics and Gynecology at Peking University People's Hospital for their meticulous patient follow‐up and invaluable contributions to this study. The authors would like to express their gratitude to EditSprings (https://www.editsprings.com) for the expert linguistic services provided.
DATA AVAILABILITY STATEMENT
Data used for this article will be shared by the corresponding author upon reasonable request.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Figure S1. Cumulative recurrence‐free survival (RFS) curves in the childbearing (N = 73) and non‐childbearing (N = 139) groups for patients with EC/AEH receiving FST. Patients with successful childbearing had longer RFS compared to patients in the non‐childbearing group (p = 0.002).
Figure S2. Subgroup analyses of RFS curves on histological type and age for patients undergoing FST, stratified by childbearing status. Live birth was associated with a significant improvement in RFS in the EC subgroup (p = 0.0062) (A), whereas only a marginal benefit was observed in the AEH subgroup (p = 0.092) (B). Live birth conferred a significant prognostic advantage in patients <35 years old (p < 0.001) (C), while no significant benefit was observed in the ≥35 years subgroup (p = 0.421) (D).
Table S1. Baseline characteristics of 212 patients in the childbearing and non‐childbearing groups.
Table S2. Reproductive outcomes of 73 childbearing patients.
Table S3. Characteristics of 41 AEH and 30 EC patients with or without postpartum recurrence.
Data Availability Statement
Data used for this article will be shared by the corresponding author upon reasonable request.