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Metformin and progestins in women with atypical hyperplasia or endometrial cancer: systematic review and meta-analysis

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Abstract

Purpose

To assess metformin's effectiveness in adding it to progestin-based hormone therapy for treating atypical endometrial hyperplasia (AEH) and early endometrial cancer (EEC).

Methods

We conducted a systematic review and meta-analysis following PRISMA guidelines (registration number CRD42023399094). We searched databases for studies up to March 2023, including randomized and non-randomized clinical trials in English.

Results

Out of 280 studies, 9 studies (1104 patients) were eligible. A total of 408 patients were allocated to receive metformin, and 696 patients entered the control group. Primary analysis focused on evaluating the CR showed a significant difference in patients with AEH treated with metformin (RR = 1.10, 95% CI 1.02−1.20, p = 0.02). Relapse rate (RR = 0.62, 95% CI 0.33−1.17, p = 0.14) was also evaluated. Secondary analysis indicated higher pregnancy rates (RR = 1.28, 95% CI 1.04−1.57, p = 0.02) with no significant difference in live birth rates (RR = 0.56, 95% CI 0.29−1.10, p = 0.09).

Conclusion

Combined therapy is effective. Metformin shows superiority to the standard regimen in achieving better CR rate in patients with AEH and benefits pregnancy rates but not recurrence or live birth rates. Therefore, the ideal fertility-sparing treatment for EC has not yet been determined and further clinical trials are needed.

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References

  1. Siegel RL, Miller KD, Fuchs HE, Jemal A (2021) Cancer statistics 2021. CA Cancer J Clin 71(1):7–33

    Article  PubMed  Google Scholar 

  2. Kurman RJ, Kaminski PF, Norris HJ (1985) The behavior of endometrial hyperplasia a long-term study of “untreated” hyperplasia in 170 patients. Cancer 56(2):403–412

    Article  CAS  PubMed  Google Scholar 

  3. Koh WJ, Abu-Rustum NR, Bean S, Bradley K, Campos SM, Cho KR, Chon HS, Chu C, Cohn D, Crispens MA, Damast S, Dorigo O, Eifel PJ, Fisher CM, Frederick P, Gaffney DK, George S, Han E, Higgins S, Huh WK, Lurain Mariani JRA, Mutch D, Nagel C, Nekhlyudov L, Fader AN, Remmenga SW, Reynolds RK, Tillmanns T, Ueda S, Wyse E, Yashar CM, McMillian NR, Scavone JL (2018) Uterine neoplasms, version 1.2018, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw: JNCCN 16(2):170–199. https://doi.org/10.6004/jnccn.2018.0006

    Article  PubMed  Google Scholar 

  4. Rodolakis A, Biliatis I, Morice P, Reed N, Mangler M, Kesic V, Denschlag D (2015) European society of gynecological oncology task force for fertility preservation: clinical recommendations for fertility-sparing management in young endometrial cancer patients. Int J Gynecol Cancer: Off J Int Gynecol Cancer Soc 25(7):1258–1265. https://doi.org/10.1097/IGC.0000000000000493

    Article  Google Scholar 

  5. Eskander RN, Randall LM, Berman ML, Tewari KS, Disaia PJ, Bristow RE (2011) Fertility preserving options in patients with gynecologic malignancies. Am J Obstet Gynecol 205(2):103–110. https://doi.org/10.1016/j.ajog.2011.01.025

    Article  PubMed  PubMed Central  Google Scholar 

  6. Leblanc E, Narducci F, Ferron G, Querleu D (2009) Indications and teaching of fertility preservation in the surgical management of gynecologic malignancies: European perspective. Gynecol Oncol 114(2 Suppl):S32–S36. https://doi.org/10.1016/j.ygyno.2009.04.010

    Article  CAS  PubMed  Google Scholar 

  7. Bokhman JV, Chepick OF, Volkova AT, Vishnevsky AS (1985) Can primary endometrial carcinoma stage I be cured without surgery and radiation therapy? Gynecol Oncol 20(2):139–155. https://doi.org/10.1016/0090-8258(85)90135-0

    Article  CAS  PubMed  Google Scholar 

  8. Rodolakis A, Scambia G, Planchamp F, Acien M, Di Spiezio Sardo A, Farrugia M, Grynberg M, Pakiz M, Pavlakis K, Vermeulen N, Zannoni G, Zapardiel I, Macklon KLT (2023) ESGO/ESHRE/ESGE guidelines for the fertility-sparing treatment of patients with endometrial carcinoma. Human Reprod Open. https://doi.org/10.1093/hropen/hoac057

    Article  Google Scholar 

  9. Gallos ID, Yap J, Rajkhowa M, Luesley DM, Coomarasamy A, Gupta JK (2012) Regression, relapse, and live birth rates with fertility-sparing therapy for endometrial cancer and atypical complex endometrial hyperplasia: a systematic review and metaanalysis. Am J Obstet Gynecol. https://doi.org/10.1016/j.ajog.2012.08.011

    Article  PubMed  Google Scholar 

  10. Qin Y, Yu Z, Yang J, Cao D, Yu M, Wang Y, Shen K (2016) Oral progestin treatment for early-stage endometrial cancer: a systematic review and meta-analysis. Int J Gynecol Cancer: Off J Int Gynecol Cancer Soc 26(6):1081–1091. https://doi.org/10.1097/IGC.0000000000000723

    Article  Google Scholar 

  11. Gunderson CC, Fader AN, Carson KA, Bristow RE (2012) Oncologic and reproductive outcomes with progestin therapy in women with endometrial hyperplasia and grade 1 adenocarcinoma: a systematic review. Gynecol Oncol 125(2):477–482. https://doi.org/10.1016/j.ygyno.2012.01.003

    Article  CAS  PubMed  Google Scholar 

  12. Meireles CG, Pereira SA, Valadares LP, Rêgo DF, Simeoni LA, Guerra ENS, Lofrano-Porto A (2017) Effects of metformin on endometrial cancer: systematic review and meta-analysis. Gynecol Oncol 147(1):167–180. https://doi.org/10.1016/j.ygyno.2017.07.120

    Article  CAS  PubMed  Google Scholar 

  13. Han MS, Lee HJ, Park SJ, Hong SP, Cheon JH, Kim WH, Kim TI (2017) The effect of metformin on the recurrence of colorectal adenoma in diabetic patients with previous colorectal adenoma. Int J Colorectal Dis 32(8):1223–1226. https://doi.org/10.1007/s00384-017-2782-z

    Article  PubMed  Google Scholar 

  14. Hall C, Stone RL, Gehlot A, Zorn KK, Burnett AF (2016) Use of metformin in obese women with type I endometrial cancer is associated with a reduced incidence of cancer recurrence. Int J Gynecol Cancer: Off J Int Gynecol Cancer Soc 26(2):313–317. https://doi.org/10.1097/IGC.0000000000000603

    Article  Google Scholar 

  15. Cochrane Handbook for Systematic Reviews of Interventions. 1st (ed.). / ed.Higgins J.P.T. et al Wiley 2019. https://doi.org/10.1002/9781119536604

  16. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, Cates CJ, Cheng HY, Corbett MS, Eldridge SM, Emberson JR, Hernán MA, Hopewell S, Hróbjartsson A, Junqueira DR, Jüni P, Kirkham JJ, Lasserson T, Li T, McAleenan A, Reeves BC, Shepperd S, Shrier I, Stewart LA, Tilling K, White IR, Whiting PF, Higgins JPT (2019) RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ (Clin Res Ed) 366:l4898. https://doi.org/10.1136/bmj.l4898

    Article  Google Scholar 

  17. Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, Carpenter JR, Chan AW, Churchill R, Deeks JJ, Hróbjartsson A, Kirkham J, Jüni P, Loke YK, Pigott TD, Ramsay CR, Regidor D, Rothstein HR, Sandhu L, Santaguida PL, Schünemann HJ, Shea B, Shrier I, Tugwell P, Turner L, Valentine JC, Waddington H, Waters E, Wells GA, Whiting PF, Higgins JP (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ (Clin Res Ed) 355:i4919. https://doi.org/10.1136/bmj.i4919

    Article  Google Scholar 

  18. Yang BY, Gulinazi Y, Du Y, Ning CC, Cheng YL, Shan WW, Luo XZ, Zhang HW, Zhu Q, Ma FH, Liu J, Sun L, Yu M, Guan J, Chen XJ (2020) Metformin plus megestrol acetate compared with megestrol acetate alone as fertility-sparing treatment in patients with atypical endometrial hyperplasia and well-differentiated endometrial cancer: a randomised controlled trial. BJOG: Int J Obstet Gynaecol 127(7):848–857. https://doi.org/10.1111/1471-0528.16108

    Article  Google Scholar 

  19. Janda M, Robledo KP, Gebski V, Armes JE, Alizart M, Cummings M, Chen C, Leung Y, Sykes P, McNally O, Oehler MK, Walker G, Garrett A, Tang A, Land R, Nicklin JL, Chetty N, Perrin LC, Hoet G, Sowden K, Eva L, Tristram A, Obermair A (2021) Complete pathological response following levonorgestrel intrauterine device in clinically stage 1 endometrial adenocarcinoma: results of a randomized clinical trial. Gynecol Oncol 161(1):143–151. https://doi.org/10.1016/j.ygyno.2021.01.029

    Article  CAS  PubMed  Google Scholar 

  20. Kong WY, Liu ZA, Zhang N, Wu X, Zhao XB, Yan L (2022) A prospective cohort study of metformin as an adjuvant therapy for infertile women with endometrial complex hyperplasia/complex atypical hyperplasia and their subsequent assisted reproductive technology outcomes. Front Endocrinol 13:849794. https://doi.org/10.3389/fendo.2022.849794

    Article  Google Scholar 

  21. Shan W, Wang C, Zhang Z, Gu C, Ning C, Luo X, Zhou Q, Chen X (2014) Conservative therapy with metformin plus megestrol acetate for endometrial atypical hyperplasia. J Gynecol Oncol 25(3):214–220. https://doi.org/10.3802/jgo.2014.25.3.214

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Acosta-Torres S, Murdock T, Matsuno R, Beavis AL, Stone RL, Wethington SL, Levinson K, Grumbine F, Ferriss JS, Tanner EJ, Fader AN (2020) The addition of metformin to progestin therapy in the fertility-sparing treatment of women with atypical hyperplasia/endometrial intraepithelial neoplasia or endometrial cancer: little impact on response and low live-birth rates. Gynecol Oncol 157(2):348–356. https://doi.org/10.1016/j.ygyno.2020.02.008

    Article  CAS  PubMed  Google Scholar 

  23. Matsuo K, Mandelbaum RS, Ciccone M, Khoshchehreh M, Pursuwani H, Morocco EB, Matsuzaki S, Dancz CE, Ozel B, Paulson RJ, Roman L (2020) Route-specific association of progestin therapy and concurrent metformin use in obese women with complex atypical hyperplasia. Int J Gynecol Cancer: Off J Int Gynecol Cancer Soc 30(9):1331–1339. https://doi.org/10.1136/ijgc-2020-001362

    Article  Google Scholar 

  24. Mitsuhashi A, Habu Y, Kobayashi T, Kawarai Y, Ishikawa H, Usui H, Shozu M (2019) Long-term outcomes of progestin plus metformin as a fertility-sparing treatment for atypical endometrial hyperplasia and endometrial cancer patients. J Gynecol Oncol 30(6):e90. https://doi.org/10.3802/jgo.2019.30.e90

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Zhou R, Yang Y, Lu Q, Wang J, Miao Y, Wang S, Wang Z, Zhao C, Wei L (2015) Prognostic factors of oncological and reproductive outcomes in fertility-sparing treatment of complex atypical hyperplasia and low-grade endometrial cancer using oral progestin in Chinese patients. Gynecol Oncol 139(3):424–428. https://doi.org/10.1016/j.ygyno.2015.09.078

    Article  CAS  PubMed  Google Scholar 

  26. Yuan F, Hu Y, Han X, Li Q (2022) Metformin in combination with progesterone improves the pregnancy rate for patients with early endometrial cancer. Contrast Media Mol Imaging 2022:1961016. https://doi.org/10.1155/2022/1961016

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. McGuinness LA, Higgins JPT (2021) Risk-of-bias VISualization (robvis): an R package and shiny web app for visualizing risk-of-bias assessments. Res Synth Methods 12(1):55–61. https://doi.org/10.1002/jrsm.1411

    Article  PubMed  Google Scholar 

  28. Mentrikoski MJ, Shah AA, Hanley KZ, Atkins KA (2012) Assessing endometrial hyperplasia and carcinoma treated with progestin therapy. Am J Clin Pathol 138(4):524–534. https://doi.org/10.1309/AJCPM2TSDDF1MHBZ

    Article  PubMed  Google Scholar 

  29. Koskas M, Uzan J, Luton D, Rouzier R, Daraï E (2014) Prognostic factors of oncologic and reproductive outcomes in fertility-sparing management of endometrial atypical hyperplasia and adenocarcinoma: systematic review and meta-analysis. Fertil Steril 101(3):785–794. https://doi.org/10.1016/j.fertnstert.2013.11.028

    Article  PubMed  Google Scholar 

  30. Dhar KK, NeedhiRajan T, Koslowski M, Woolas RP (2005) Is levonorgestrel intrauterine system effective for treatment of early endometrial cancer? Report of four cases and review of the literature. Gynecol Oncol 97(3):924–927. https://doi.org/10.1016/j.ygyno.2004.10.031

    Article  CAS  PubMed  Google Scholar 

  31. Wei J, Zhang W, Feng L, Gao W (2017) Comparison of fertility-sparing treatments in patients with early endometrial cancer and atypical complex hyperplasia: a meta-analysis and systematic review. Medicine 96(37):e8034. https://doi.org/10.1097/MD.0000000000008034

    Article  PubMed  PubMed Central  Google Scholar 

  32. Marnach ML, Butler KA, Henry MR, Hutz CE, Langstraat CL, Lohse CM, Casey PM (2017) Oral progestogens versus levonorgestrel-releasing intrauterine system for treatment of endometrial intraepithelial neoplasia. J Women’s Health 26(4):368–373. https://doi.org/10.1089/jwh.2016.5774

    Article  Google Scholar 

  33. Hubbs JL, Saig RM, Abaid LN, Bae-Jump VL, Gehrig PA (2013) Systemic and local hormone therapy for endometrial hyperplasia and early adenocarcinoma. Obstet Gynecol 121(6):1172–1180. https://doi.org/10.1097/AOG.0b013e31828d6186

    Article  CAS  PubMed  Google Scholar 

  34. Tamauchi S, Kajiyama H, Utsumi F, Suzuki S, Niimi K, Sakata J, Mizuno M, Shibata K, Kikkawa F (2018) Efficacy of medroxyprogesterone acetate treatment and retreatment for atypical endometrial hyperplasia and endometrial cancer. J Obstet Gynaecol Res 44(1):151–156. https://doi.org/10.1111/jog.13473

    Article  CAS  PubMed  Google Scholar 

  35. Ushijima K, Yahata H, Yoshikawa H, Konishi I, Yasugi T, Saito T, Nakanishi T, Sasaki H, Saji F, Iwasaka T, Hatae M, Kodama S, Saito T, Terakawa N, Yaegashi N, Hiura M, Sakamoto A, Tsuda H, Fukunaga M, Kamura T (2007) Multicenter phase II study of fertility-sparing treatment with medroxyprogesterone acetate for endometrial carcinoma and atypical hyperplasia in young women. J clinical oncol: Off J Am Soc Clinical Oncol 25(19):2798–2803. https://doi.org/10.1200/JCO.2006.08.8344

    Article  CAS  Google Scholar 

  36. Mandelbaum RS, Ciccone MA, Nusbaum DJ, Khoshchehreh M, Purswani H, Morocco EB, Smith MB, Matsuzaki S, Dancz CE, Ozel B, Roman LD, Paulson RJ, Matsuo K (2020) Progestin therapy for obese women with complex atypical hyperplasia: levonorgestrel-releasing intrauterine device vs systemic therapy. Am J Obstet Gynecol 223(1):103.e1-103.e13. https://doi.org/10.1016/j.ajog.2019.12.273

    Article  CAS  PubMed  Google Scholar 

  37. Edelman AB, Carlson NE, Cherala G, Munar MY, Stouffer RL, Cameron JL, Stanczyk FZ, Jensen JT (2009) Impact of obesity on oral contraceptive pharmacokinetics and hypothalamic-pituitary-ovarian activity. Contraception 80(2):119–127. https://doi.org/10.1016/j.contraception.2009.04.011

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Yang B, Xie L, Zhang H, Zhu Q, Du Y, Luo X, Chen X (2018) Insulin resistance and overweight prolonged fertility-sparing treatment duration in endometrial atypical hyperplasia patients. J Gynecol Oncol 29(3):e35. https://doi.org/10.3802/jgo.2018.29.e35

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Apgar BS, Greenberg G (2000) Using progestins in clinical practice. Am Fam Phys 62(8):1839–1850

    CAS  Google Scholar 

  40. Ko EM, Walter P, Jackson A, Clark L, Franasiak J, Bolac C, Havrilesky LJ, Secord AA, Moore DT, Gehrig PA, Bae-Jump V (2014) Metformin is associated with improved survival in endometrial cancer. Gynecol Oncol 132(2):438–442. https://doi.org/10.1016/j.ygyno.2013.11.021

    Article  CAS  PubMed  Google Scholar 

  41. Zhang Y, Liu Z, Yu X, Zhang X, Lü S, Chen X, Lü B (2010) The association between metabolic abnormality and endometrial cancer: a large case-control study in China. Gynecol Oncol 117(1):41–46. https://doi.org/10.1016/j.ygyno.2009.12.029

    Article  CAS  PubMed  Google Scholar 

  42. Pierotti MA, Berrino F, Gariboldi M, Melani C, Mogavero A, Negri T, Pasanisi P, Pilotti S (2013) Targeting metabolism for cancer treatment and prevention: metformin, an old drug with multi-faceted effects. Oncogene 32(12):1475–1487. https://doi.org/10.1038/onc.2012.181

    Article  CAS  PubMed  Google Scholar 

  43. Markowska A, Pawałowska M, Filas V, Korski K, Gryboś M, Sajdak S, Olejek A, Bednarek W, Spiewankiewicz B, Lubin J, Markowska J (2013) Does metformin affect ER, PR, IGF-1R, β-catenin and PAX-2 expression in women with diabetes mellitus and endometrial cancer? Diabetol Metab Syndr 5(1):76. https://doi.org/10.1186/1758-5996-5-76

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Gu W, Mitsuhashi A, Kobayashi T, Shozu M (2022) Metformin attenuates the production and proliferative effects of prolactin induced by medroxyprogesterone acetate during fertility-sparing treatment for endometrial cancer. BMC Cancer 22(1):753. https://doi.org/10.1186/s12885-022-09858-w

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Fan Y, Li X, Wang J, Wang Y, Tian L, Wang J (2021) Analysis of pregnancy-associated factors after fertility-sparing therapy in young women with early stage endometrial cancer or atypical endometrial hyperplasia. Reprod Biol Endocrinol: RB&E 19(1):118. https://doi.org/10.1186/s12958-021-00808-y

    Article  CAS  Google Scholar 

  46. Chen M, Jin Y, Li Y, Bi Y, Shan Y, Pan L (2016) Oncologic and reproductive outcomes after fertility-sparing management with oral progestin for women with complex endometrial hyperplasia and endometrial cancer. Int J Gynaecol Obstet: Off Org Int Federation Gynaecol Obstet 132(1):34–38. https://doi.org/10.1016/j.ijgo.2015.06.046

    Article  Google Scholar 

  47. Chae SH, Shim SH, Lee SJ, Lee JY, Kim SN, Kang SB (2019) Pregnancy and oncologic outcomes after fertility-sparing management for early stage endometrioid endometrial cancer. Int J Gynecol Cancer: Off J Int Gynecol Cancer Soc 29(1):77–85. https://doi.org/10.1136/ijgc-2018-000036

    Article  Google Scholar 

  48. Novikova OV, Nosov VB, Panov VA, Novikova EG, Krasnopolskaya KV, Andreeva YY, Shevchuk AS (2021) Live births and maintenance with levonorgestrel IUD improve disease-free survival after fertility-sparing treatment of atypical hyperplasia and early endometrial cancer. Gynecol Oncol 161(1):152–159. https://doi.org/10.1016/j.ygyno.2021.01.001

    Article  CAS  PubMed  Google Scholar 

  49. Jing CY, Li SN, Shan BE, Zhang W, Tian WJ, Ren YL, Wang HY (2022) Hysteroscopic curettage followed by megestrol acetate plus metformin as a fertility-sparing treatment for women with atypical endometrial hyperplasia or well-differentiated endometrioid endometrial carcinoma. Clinical Med Insights Oncol. https://doi.org/10.1177/11795549221110522

    Article  Google Scholar 

  50. Giampaolino P, Di Spiezio Sardo A, Mollo A, Raffone A, Travaglino A, Boccellino A, Zizolfi B, Insabato L, Zullo F, De Placido G, Bifulco G (2019) Hysteroscopic endometrial focal resection followed by levonorgestrel intrauterine device insertion as a fertility-sparing treatment of atypical endometrial hyperplasia and early endometrial cancer: a retrospective study. J Minim Invasive Gynecol 26(4):648–656. https://doi.org/10.1016/j.jmig.2018.07.001

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Moscow State University of Medicine and Dentistry Named After A.I. Evdokimov, 127473, Moscow, Russia

    Leila Adamyan

  2. FSBI «National Medical Research Center for Obstetrics, Gynecology and Perinatology Named After Academician V.I. Kulakov» Ministry of Healthcare of the Russian Federation, Moscow, Russia

    Leila Adamyan & Laura Pivazyan

  3. I.M. Sechenov First Moscow State Medical University (Sechenov University), 119048, Moscow, Russia

    Sapiyat Isaeva, Roman Shapovalenko & Araksya Zakaryan

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  1. Leila Adamyan
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  2. Laura Pivazyan
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Contributions

Adamyan Leila—protocol development, data collection; Pivazyan Laura—protocol development, data collection, manuscript writing; Isaeva Sapiyat—data collection, manuscript writing; Shapovalenko Roman—data collection, manuscript writing; Zakaryan Araksya—data collection, manuscript writing.

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Correspondence to Laura Pivazyan.

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Adamyan, L., Pivazyan, L., Isaeva, S. et al. Metformin and progestins in women with atypical hyperplasia or endometrial cancer: systematic review and meta-analysis. Arch Gynecol Obstet 309, 2289–2305 (2024). https://doi.org/10.1007/s00404-024-07416-2

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