背景:我们的目的是对评估子宫内膜非典型增生(AH)和子宫内膜样子宫内膜癌(EEC)患者行宫腔镜下保守治疗(HR)的肿瘤和生殖结局的研究进行系统评价和荟萃分析。
方法:本研究遵循系统评价和荟萃分析的首选报告项目(PRISMA)声明进行系统评价和荟萃分析。该研究严格遵循Cochrane手册提出的方法框架,并在PROSPERO(CRD42023469986)中进行了回顾性注册。搜索是在PubMed中进行的,Embase,还有Cochrane图书馆,从成立到2023年10月10日。使用基于纽卡斯尔-渥太华量表项目和非随机研究方法学指标的清单进行质量评估。这项荟萃分析的主要终点是完全缓解(CR),怀孕,EEC或AH患者基于HR治疗后的活产率。次要终点是复发率(RR)。
结果:21篇文章涉及407例临床IA期患者,低或中级等级,EEC,本系统综述包括444例接受基于HR的保守治疗的AH患者.在88.6%的EEC患者和97.0%的AH患者中,实现了CR到基于HR的保守治疗。其中,30.6%和24.2%,分别,有活产。EEC和AH患者的总体合并疾病RR分别为18.3%和10.8%,分别。进一步的子集分析显示,体重指数(BMI)≤28kg/m2的EEC患者的CR率较高,怀孕和活产的机会也较高(CR为91.6%,32.9%怀孕,31.1%的活产)与BMI>28kg/m2的患者(86.4%CR,28.4%怀孕,23.0%活产)。口服孕激素亚组的HR具有较高的CR率和较高的妊娠和活产机会(91.8%CR,36.3%怀孕,28.2%的活产)比HR其次是左炔诺孕酮宫内节育系统亚组(82.5%CR,25.3%怀孕,16.3%活产)。
结论:宫腔镜切除术后孕激素似乎是年轻AH和EEC患者保留生育治疗的有希望的选择。有有效和安全的反应。活产率仍有待通过提供医疗指导和鼓励来提高。
BACKGROUND: Our objective was to conduct a systematic
review and meta-analysis of studies evaluating the oncological and reproductive outcomes of patients with endometrial atypical hyperplasia (AH) and endometrioid endometrial cancer (EEC) undergoing conservative therapy with hysteroscopic resection (HR).
METHODS: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for systematic reviews and meta-analyses. The study strictly followed the methodological framework proposed by the Cochrane Handbook and was retrospectively registered in PROSPERO (CRD42023469986). Searches were conducted in PubMed, Embase, and the Cochrane Library, from inception to October 10, 2023. A checklist based on items of the Newcastle-Ottawa Scale and the Methodological Index for Non-randomized Studies was used for quality assessment. The primary end points for this meta-analysis were complete response (CR), pregnancy, and live birth rates following HR-based therapy in patients with EEC or AH. The secondary end point was the recurrence rate (RR).
RESULTS: Twenty-one articles involving 407 patients with clinical stage IA, low or intermediate grade, EEC, and 444 patients with AH managed with HR-based conservative treatment were included for this systematic
review. CR to HR-based conservative therapy was achieved in 88.6% of patients with EEC and 97.0% of patients with AH. Of these, 30.6% and 24.2%, respectively, had live births. The overall pooled disease RR was 18.3% and 10.8% in patients with EEC and AH, respectively. Further subset analyses revealed that EEC patients with body mass index (BMI) ≤28 kg/m2 had higher CR rates as well as higher chances of pregnancy and live birth (91.6% CR, 32.9% pregnancy, 31.1% live birth) compared with patients with BMI >28 kg/m2 (86.4% CR, 28.4% pregnancy, 23.0% live birth). The HR followed by oral progestogen subgroup had higher CR rates and higher chances of pregnancy and live birth (91.8% CR, 36.3% pregnancy, 28.2% live birth) than the HR followed by the levonorgestrel intrauterine system subgroup (82.5% CR, 25.3% pregnancy, 16.3% live birth).
CONCLUSIONS: Hysteroscopic resection followed by progestins appears to be a promising choice for fertility-sparing treatment in young patients with AH and EEC, with effective and safe responses. The live birth rate remains to be improved by providing medical guidance and encouragement.