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1065 Fertility-sparing treatment for endometrial hyperplasia with and without atypia, and early endometrial cancer: a systematic review and meta-analysis
  1. Marissa W Koh1,
  2. Laura Burney Ellis1,
  3. Konstantinos Kechagias1,
  4. Ilkka Kalliala1,
  5. Areti Veroniki2,
  6. Sarah Bowden1 and
  7. Maria Kyrgiou1
  1. 1Imperial College London, London, UK
  2. 2University of Toronto, Toronto, Canada

Abstract

Introduction/Background Around one fifth of endometrial cancers (EC) are diagnosed in premenopausal women. The standard treatment for EC, its precursor: endometrial hyperplasia with atypia (EHA), and unresolved endometrial hyperplasia (EH) is a hysterectomy. Fertility-sparing treatment has more recently been recognised as a viable option for those who wish to conceive. ESGO guidelines published in 2023 suggest that both oral progesterones and progesterone-based intra-uterine systems (LNG-IUS) are acceptable therapies, and there is no conclusive evidence as to the best treatment. Our aim was to undertake a systematic review and meta-analysis of the available literature, in order to determine the most effective treatment.

Methodology MEDLINE, EMBASE, and ongoing trial registries were systematically searched from inception to November 2023. Randomised (RCTs) and Non-Randomised studies (NRS) reporting on the rate of regression after fertility-sparing treatment of EH, EHA, and grade 1–2, presumed stage 1a EC in individuals who wished to retain fertility were included. A random-effects model was applied to calculate pooled odds ratio estimates and corresponding heterogeneity.

Results In total, 29 studies were eligible for inclusion. There were no randomised studies comparing LNG-IUS to oral progesterones for treatment of EC. Pooled estimates were calculated for EH (12 studies), EHA (8 studies), EHA and EC (17 studies), and EHA and EC where the dose of progesterones was within the range of the ESGO 2023 guidelines (7 studies). In these preliminary analyses, LNG-IUS was more favourable than oral progesterones. For EHA and EC regression, LNG-IUS OR=2.28 (95%CI 1.35–3.84); when this was restricted to only studies within the guideline dosages, OR=1.79 (95%CI 0.58–5.57).

Conclusion LNG-IUS appears to be the most effacious currently available treatment for endometrial hyperplasia with and without atypia, and early endometrial cancer. The quality of the included studies was generally low, and randomised studies with larger cohorts are urgently needed.

Disclosures N/A.

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