Abstract：
Endometrial cancer is the fifth most common cancer in women and atypical endometrial hyperplasia is a precancerous lesion. Obesity is an important risk factor for endometrioid endometrial adenocarcinoma and endometrial hyperplasia. Progesterone is recommended as first-line treatment in endometrial cancer or atypical endometrial hyperplasia in women who wish to preserve fertility, but optimal treatment schedules have not been defined. Metformin or bariatric surgery may also be useful in these women. The effectiveness and safety of fertility-preserving treatments being used for women with atypical endometrial hyperplasia and stage IA grade 1 endometrial cancer is unclear. Therefore, the systematic review aims to determine this point.
We will search the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, trial registers, conference proceedings, abstracts, cooperative trial groups and reference lists. We will include randomised controlled trials (RCTs) that compare fertility-preserving therapy including orally administered progesterone versus a levonorgestrel-releasing intrauterine system (IUS), metformin, other pharmacological interventions or bariatric surgery, and any of these interventions with womb-removing surgery. Quasi-randomised trials, non-randomised trials and cohort studies will be included. Two review authors will independently assess study eligibility and risk of bias and extract data. The primary outcomes are complete pathologic response and live birth rate. Secondary outcomes include overall survival, progression-free survival, pregnancy rate, need for hysterectomy, adverse events, psychological symptoms and quality of life.
This review aims to clarify the effectiveness and risks of fertility-preserving treatments, including complete pathologic response rate, live birth rates, need for surgical treatment, adverse events, psychological symptoms and quality of life. The broad scope of the review includes the use of progesterone, metformin to reverse insulin resistance, and bariatric surgery or operative hysteroscopy.
The results may help to determine the optimal fertility-sparing treatment in endometrial cancer and atypical endometrial hyperplasia.
Prospero 2019 number CRD42019145991.
We will search the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, trial registers, conference proceedings, abstracts, cooperative trial groups and reference lists. We will include randomised controlled trials (RCTs) that compare fertility-preserving therapy including orally administered progesterone versus a levonorgestrel-releasing intrauterine system (IUS), metformin, other pharmacological interventions or bariatric surgery, and any of these interventions with womb-removing surgery. Quasi-randomised trials, non-randomised trials and cohort studies will be included. Two review authors will independently assess study eligibility and risk of bias and extract data. The primary outcomes are complete pathologic response and live birth rate. Secondary outcomes include overall survival, progression-free survival, pregnancy rate, need for hysterectomy, adverse events, psychological symptoms and quality of life.
This review aims to clarify the effectiveness and risks of fertility-preserving treatments, including complete pathologic response rate, live birth rates, need for surgical treatment, adverse events, psychological symptoms and quality of life. The broad scope of the review includes the use of progesterone, metformin to reverse insulin resistance, and bariatric surgery or operative hysteroscopy.
The results may help to determine the optimal fertility-sparing treatment in endometrial cancer and atypical endometrial hyperplasia.
Prospero 2019 number CRD42019145991.
摘要：
子宫内膜癌是女性第五大最常见的癌症，非典型子宫内膜增生是癌前病变。肥胖是子宫内膜样腺癌和子宫内膜增生的重要危险因素。对于希望保留生育能力的子宫内膜癌或非典型子宫内膜增生的女性，推荐使用孕激素作为一线治疗。但尚未确定最佳治疗方案。二甲双胍或减肥手术也可能对这些女性有用。对于非典型子宫内膜增生和IA期1级子宫内膜癌的女性，保留生育功能的治疗的有效性和安全性尚不清楚。因此,系统审查旨在确定这一点。
我们将搜索Cochrane中央控制试验登记册（CENTRAL），MEDLINE,Embase,审判登记册，会议记录,摘要,合作试验组和参考名单。我们将包括随机对照试验（RCT），比较包括口服孕酮和左炔诺孕酮释放宫内节育系统（IUS）在内的保留生育治疗，二甲双胍,其他药物干预或减肥手术，以及任何这些子宫切除手术的干预措施。准随机试验，将纳入非随机试验和队列研究.两位综述作者将独立评估研究资格和偏倚风险，并提取数据。主要结果是完全病理反应和活产率。次要结果包括总生存率，无进展生存期,怀孕率,需要子宫切除术，不良事件,心理症状和生活质量。
这篇综述旨在阐明保留生育力治疗的有效性和风险，包括完全病理反应率，活产率,需要手术治疗，不良事件,心理症状和生活质量。审查的广泛范围包括黄体酮的使用，二甲双胍逆转胰岛素抵抗，和减肥手术或宫腔镜手术。
这些结果可能有助于确定子宫内膜癌和不典型子宫内膜增生的最佳保留生育治疗方法。
Prospero2019编号CRD42019145991。
我们将搜索Cochrane中央控制试验登记册（CENTRAL），MEDLINE,Embase,审判登记册，会议记录,摘要,合作试验组和参考名单。我们将包括随机对照试验（RCT），比较包括口服孕酮和左炔诺孕酮释放宫内节育系统（IUS）在内的保留生育治疗，二甲双胍,其他药物干预或减肥手术，以及任何这些子宫切除手术的干预措施。准随机试验，将纳入非随机试验和队列研究.两位综述作者将独立评估研究资格和偏倚风险，并提取数据。主要结果是完全病理反应和活产率。次要结果包括总生存率，无进展生存期,怀孕率,需要子宫切除术，不良事件,心理症状和生活质量。
这篇综述旨在阐明保留生育力治疗的有效性和风险，包括完全病理反应率，活产率,需要手术治疗，不良事件,心理症状和生活质量。审查的广泛范围包括黄体酮的使用，二甲双胍逆转胰岛素抵抗，和减肥手术或宫腔镜手术。
这些结果可能有助于确定子宫内膜癌和不典型子宫内膜增生的最佳保留生育治疗方法。
Prospero2019编号CRD42019145991。
