■本网络荟萃分析的目的是系统比较不同的以孕激素为基础的联合治疗方案对诊断为子宫内膜癌或非典型子宫内膜增生患者的疗效。主要目标是通过全面检查其各自的有效性来辨别最佳组合治疗方案。
■我们系统地搜索了四个著名的数据库:PubMed,WebofScience,Embase,和Cochrane中央控制试验登记册,针对针对孕激素或孕激素联合治疗子宫内膜癌或非典型子宫内膜增生患者的疗效的随机对照试验。搜索从这些数据库开始到2023年12月。关键结果指标包括生存指数,疗效评估标准,以及怀孕和复发率。本研究在PROSPERO(CRD42024496311)注册。
■从最初检索的1,558篇文章中,我们纳入了27项研究,共5,323名受试者参与我们的分析.网络荟萃分析结果表明,mTOR抑制剂醋酸甲地孕酮(MA)他莫昔芬方案在维持疾病稳定(SD)(SUCRA=73.4%)和延长无进展生存期(PFS)(SUCRA=72.4%)方面排名最高。此外,孕激素联合他莫昔芬方案在提高部分缓解(PR)(SUCRA=75.2%)和延长总生存期(OS)(SUCRA=80%)方面占据主导地位.基于LNG-IUS的双孕激素方案成为改善完全反应(CR)的领跑者(SUCRA=98.7%),客观反应率(ORR)(SUCRA=99.1%),妊娠率(SUCRA=83.7%),和缓解进展(SUCRA=8.0%)和复发率(SUCRA=47.4%)。在安全方面,基于LNG-IUS的双孕激素方案发生不良事件的可能性最低(SUCRA=4.2%),而mTOR抑制剂方案(SUCRA=89.2%)和mTORinbitor+MA+他莫昔芬方案(SUCRA=88.4%)发生不良事件的可能性最高.
■诊断为子宫内膜癌或非典型子宫内膜增生的患者在接受包括他莫昔芬的孕激素联合治疗时表现出最有利的预后,mTOR抑制剂,或LNG-IUS。值得注意的是,在这些选项中,基于LNG-IUS的双孕激素方案特别具有潜在应用前景.
■https://www.crd.约克。AC.英国/PROSPERO,标识符CRD42024496311。
UNASSIGNED: The objective of this network meta-analysis is to systematically compare the efficacy of diverse progestin-based combination regimens in treating patients diagnosed with endometrial cancer or atypical endometrial hyperplasia. The primary goal is to discern the optimal combination treatment regimen through a comprehensive examination of their respective effectiveness.
UNASSIGNED: We systematically searched four prominent databases: PubMed, Web of Science, Embase, and Cochrane Central Register of Controlled Trials, for randomized controlled trials addressing the efficacy of progestins or progestin combinations in the treatment of patients with endometrial cancer or atypical endometrial hyperplasia. The search spanned from the inception of these databases to December 2023. Key outcome indicators encompassed survival indices, criteria for assessing efficacy, as well as pregnancy and relapse rate. This study was registered in PROSPERO (CRD42024496311).
UNASSIGNED: From the 1,558 articles initially retrieved, we included 27 studies involving a total of 5,323 subjects in our analysis. The results of the network meta-analysis revealed that the mTOR inhibitor+megestrol acetate (MA)+tamoxifen regimen secured the top rank in maintaining stable disease (SD) (SUCRA=73.4%) and extending progression-free survival (PFS) (SUCRA=72.4%). Additionally, the progestin combined with tamoxifen regimen claimed the leading position in enhancing the partial response (PR) (SUCRA=75.2%) and prolonging overall survival (OS) (SUCRA=80%). The LNG-IUS-based dual progestin regimen emerged as the frontrunner in improving the complete response (CR) (SUCRA=98.7%), objective response rate (ORR) (SUCRA=99.1%), pregnancy rate (SUCRA=83.7%), and mitigating progression (SUCRA=8.0%) and relapse rate (SUCRA=47.4%). In terms of safety, The LNG-IUS-based dual progestin regimen had the lowest likelihood of adverse events (SUCRA=4.2%), while the mTOR inhibitor regimen (SUCRA=89.2%) and mTOR inbitor+MA+tamoxifen regimen (SUCRA=88.4%) had the highest likelihood of adverse events.
UNASSIGNED: Patients diagnosed with endometrial cancer or atypical endometrial hyperplasia exhibited the most favorable prognosis when undergoing progestin combination therapy that included tamoxifen, mTOR inhibitor, or LNG-IUS. Notably, among these options, the LNG-IUS-based dual progestin regimen emerged as particularly promising for potential application.
UNASSIGNED: https://www.crd.york.ac.uk/PROSPERO, identifier CRD42024496311.