Article Text

Download PDFPDF

Fertility-Preserving Treatment in Young Women With Grade 1 Presumed Stage IA Endometrial Adenocarcinoma: A Meta-Analysis
  1. Zunpan Fan, MD*,
  2. Hui Li, MD,
  3. Rui Hu, MD*,
  4. Yuling Liu, MD*,
  5. Xinyu Liu, MD* and
  6. Liping Gu, MD*
  1. *Department of Obstetrics and Gynecology, The Second Bethune Hospital of Jilin University, Changchun City, Jilin Province; and
  2. Department of Obstetrics and Gynecology, Henan Provincial People’s Hospital, Zhengzhou Shi, Henan Sheng, China.
  1. Address correspondence and reprint requests to Liping Gu, MD, Department of Obstetrics and Gynecology, The Second Bethune Hospital of Jilin University, 218 Ziqiang Ave, Nanguan District, Changchun City, Jilin Province 130041, China. E-mail: guliping1233211@163.com.

Abstract

Objectives The aim of this study was to investigate the different efficacies of various fertility-preserving therapies for grade 1 presumed stage IA endometrial cancer.

Methods We searched the major online databases (PubMed, MEDLINE, Cochrane Library, Web of Science, and Ovid) and retrieved all the research on fertility-preserving treatment for young, grade 1 presumed stage IA endometrial adenocarcinoma patients since January 2000. We used the systemic evaluation of the Cochrane Collaboration to select the literature and merge the data we collected using R3.2.2 software (R Development Core Team, Auckland, New Zealand). By comparing the remission, recurrence, and pregnancy rates, we evaluated the efficiency of 3 existing fertility-preserving treatments indirectly: a) taking oral progestin only therapy, b) hysteroscopic resection followed by progestin therapy, and c) intrauterine progestin therapy: levonorgestrel-releasing intrauterine system combined with gonadotropin-releasing hormone agonist/progestin therapy.

Results Twenty-eight studies met the selection criteria. A total of 619 cases were included in this study. The group that took oral progestin only (456 patients) achieved a complete remission rate (CRR), recurrence rate (ReR), and pregnancy rate (PregR) of 76.3%, (95% confidence interval [CI], 70.7%–81.1%); 30.7% (95% CI, 21.0%–42.4%); and 52.1% (95% CI, 41.2%–66.0%), respectively. The hysteroscopic resection followed by progestin therapy group (73 patients) achieved a CRR, ReR, and PregR of 95.3% (95% CI, 87.8%–100%); 14.1% (95% CI, 7.1%–26.1%); and 47.8% (95% CI, 33.0%–69.5%), respectively. The intrauterine progestin therapy group (90 patients) achieved a CRR, ReR, and PregR of 72.9% (95% CI, 60.4%–82.5%); 11.0% (95% CI, 5.1%–22.0%); and 56.0% (95% CI, 37.3%–73.1%), respectively.

Conclusions The existing results show that patients who received hysteroscopic resection followed by progestin therapy achieved the highest CRR. Patients who received oral progestin only might be more likely to recur and have more systemic adverse effects. Recent intrauterine progestin therapy such as levonorgestrel-releasing intrauterine system combined with gonadotropin-release hormone receptor agonist/progestin have a satisfactory PregR and low ReR rate. Considering the inherent limitations of the studies we included, further well-designed, randomized controlled trials are necessary to confirm and update this analysis.

  • Endometrial cancer
  • Fertility-preserving
  • Levonorgestrel
  • Progestin
  • Hysteroscopy

Statistics from Altmetric.com

Footnotes

  • The authors declare no conflicts of interest.

  • Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal’s Web site (www.ijgc.net).

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.