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Effects of hysteroscopic surgery combined with progesterone therapy on fertility and prognosis in patients with early endometrial cancer and atypical endometrial hyperplasia or endometrial intraepithelial neoplasia: a meta-analysis

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

This meta-analysis aimed to evaluate the effects of hysteroscopic surgery combined with progesterone therapy on fertility and prognosis in patients with early endometrial cancer (EC), atypical endometrial hyperplasia (AEH), or endometrial intraepithelial neoplasia (EIN).

Methods

Studies on hysteroscopic surgery combined with progesterone therapy for patients with early-stage EC, AEH, or EIN were searched from Embase, Web of Science, PubMed, and Cochrane Library databases. The included studies contained one or more of the following outcome variables: pregnancy rate, live birth rate, complete response (CR) rate, and recurrence rate after conservative treatment. The meta-analysis was performed using Stata.

Results

13 pieces of literature containing 239 patients with EC and 199 patients with AEH/EIN were included. As per the results of meta-analysis, the pregnancy rates of EC patients and AEH/EIN patients were 49% (95% CI 33–65%) and 47% (95% CI 31–64%), respectively, and the live birth rates were 45% (95% CI 32–58%) and 44% (95% CI 34–54%), respectively. CR rates of EC patients and AEH/EIN patients were 90% (95% CI 85–94%) and 100% (95% CI 97–100%), respectively, and the disease recurrence rates were 17% (95% CI 8–28%) and 11% (95% CI 3–23%), respectively.

Conclusion

Hysteroscopic surgery combined with progesterone was linked to an improved overall response rate, reduced disease recurrence rate, and increased pregnancy and live birth rates among patients with EC and AEH/EIN.

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Data availability

The data that support the findings of this study are available from the corresponding author.

References

  1. Ferlay J et al (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136:E359-386. https://doi.org/10.1002/ijc.29210

    Article  CAS  PubMed  Google Scholar 

  2. Gaber C, Meza R, Ruterbusch JJ, Cote ML (2016) Endometrial cancer trends by race and histology in the USA: projecting the number of new cases from 2015 to 2040. J Racial Ethn Health Disparities. https://doi.org/10.1007/s40615-016-0292-2

    Article  PubMed  PubMed Central  Google Scholar 

  3. Weiderpass E, Antoine J, Bray FI, Oh JK, Arbyn M (2014) Trends in corpus uteri cancer mortality in member states of the European Union. Eur J Cancer 50:1675–1684. https://doi.org/10.1016/j.ejca.2014.02.020

    Article  PubMed  Google Scholar 

  4. Tomao F et al (2016) Special issues in fertility preservation for gynecologic malignancies. Crit Rev Oncol Hematol 97:206–219. https://doi.org/10.1016/j.critrevonc.2015.08.024

    Article  PubMed  Google Scholar 

  5. Falcone F et al (2014) Surgical management of early endometrial cancer: an update and proposal of a therapeutic algorithm. Med Sci Monit 20:1298–1313. https://doi.org/10.12659/MSM.890478

    Article  PubMed  PubMed Central  Google Scholar 

  6. Koh WJ et al (2018) Uterine neoplasms, version 1.2018, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 16:170–199. https://doi.org/10.6004/jnccn.2018.0006

    Article  PubMed  Google Scholar 

  7. Corzo C, Barrientos Santillan N, Westin SN, Ramirez PT (2018) Updates on conservative management of endometrial cancer. J Minim Invasive Gynecol 25:308–313. https://doi.org/10.1016/j.jmig.2017.07.022

    Article  PubMed  Google Scholar 

  8. Falcone F et al (2020) Fertility-sparing treatment for intramucous, moderately differentiated, endometrioid endometrial cancer: a gynecologic cancer inter-group (GCIG) study. J Gynecol Oncol 31:e74. https://doi.org/10.3802/jgo.2020.31.e74

    Article  PubMed  PubMed Central  Google Scholar 

  9. Park JY et al (2013) Long-term oncologic outcomes after fertility-sparing management using oral progestin for young women with endometrial cancer (KGOG 2002). Eur J Cancer 49:868–874. https://doi.org/10.1016/j.ejca.2012.09.017

    Article  CAS  PubMed  Google Scholar 

  10. Yang B et al (2019) Treatment efficiency of comprehensive hysteroscopic evaluation and lesion resection combined with progestin therapy in young women with endometrial atypical hyperplasia and endometrial cancer. Gynecol Oncol 153:55–62. https://doi.org/10.1016/j.ygyno.2019.01.014

    Article  CAS  PubMed  Google Scholar 

  11. Herrera Cappelletti E, Humann J, Torrejon R, Gambadauro P (2022) Chances of pregnancy and live birth among women undergoing conservative management of early-stage endometrial cancer: a systematic review and meta-analysis. Hum Reprod Update 28:282–295. https://doi.org/10.1093/humupd/dmab041

    Article  CAS  PubMed  Google Scholar 

  12. Murad MH, Sultan S, Haffar S, Bazerbachi F (2018) Methodological quality and synthesis of case series and case reports. BMJ Evid Based Med 23:60–63. https://doi.org/10.1136/bmjebm-2017-110853

    Article  PubMed  PubMed Central  Google Scholar 

  13. Wang CJ et al (2014) Fertility-preserving treatment in young women with endometrial adenocarcinoma: a long-term cohort study. Int J Gynecol Cancer 24:718–728. https://doi.org/10.1097/IGC.0000000000000098

    Article  PubMed  Google Scholar 

  14. Wang Q et al (2015) Fertility-conservation combined therapy with hysteroscopic resection and oral progesterone for local early stage endometrial carcinoma in young women. Int J Clin Exp Med 8:13804–13810

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Falcone F et al (2017) Fertility preserving treatment with hysteroscopic resection followed by progestin therapy in young women with early endometrial cancer. J Gynecol Oncol 28:e2. https://doi.org/10.3802/jgo.2017.28.e2

    Article  PubMed  Google Scholar 

  16. Wang F et al (2017) Fertility preserved hysteroscopic approach for the treatment of stage Ia endometrioid carcinoma. Int J Gynecol Cancer 27:1919–1925. https://doi.org/10.1097/IGC.0000000000001109

    Article  PubMed  PubMed Central  Google Scholar 

  17. Casadio P et al (2018) Fertility-sparing treatment of endometrial cancer with initial infiltration of myometrium by resectoscopic surgery: a pilot study. Oncologist 23:478–480. https://doi.org/10.1634/theoncologist.2017-0285

    Article  PubMed  PubMed Central  Google Scholar 

  18. Giampaolino P et al (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 26:648–656. https://doi.org/10.1016/j.jmig.2018.07.001

    Article  PubMed  Google Scholar 

  19. Yang HC, Liu JC, Liu FS (2019) Fertility-preserving treatment of stage IA, well-differentiated endometrial carcinoma in young women with hysteroscopic resection and high-dose progesterone therapy. Taiwan J Obstet Gynecol 58:90–93. https://doi.org/10.1016/j.tjog.2018.11.017

    Article  PubMed  Google Scholar 

  20. Ayhan A, Tohma YA, Tunc M (2020) Fertility preservation in early-stage endometrial cancer and endometrial intraepithelial neoplasia: a single-center experience. Taiwan J Obstet Gynecol 59:415–419. https://doi.org/10.1016/j.tjog.2020.03.014

    Article  PubMed  Google Scholar 

  21. Casadio P et al (2020) Fertility sparing treatment of endometrial cancer with and without initial infiltration of myometrium: a single center experience. Cancers (Basel). https://doi.org/10.3390/cancers12123571

    Article  PubMed  Google Scholar 

  22. Mazzon I, Masciullo V, Scambia G, Ferrandina G, Corrado G (2020) Long-term survival of young endometrial cancer patients desiring fertility preservation treated with hysteroscopic resection followed by hormone therapy (NEMO technique). Int J Gynaecol Obstet 151:305–307. https://doi.org/10.1002/ijgo.13253

    Article  PubMed  Google Scholar 

  23. Atallah D et al (2021) The use of hysteroscopic endometrectomy in the conservative treatment of early endometrial cancer and atypical hyperplasia in fertile women. Arch Gynecol Obstet 304:1299–1305. https://doi.org/10.1007/s00404-021-06048-0

    Article  CAS  PubMed  Google Scholar 

  24. Raffone A et al (2021) Clinical predictive factors of response to treatment in patients undergoing conservative management of atypical endometrial hyperplasia and early endometrial cancer. J Adolesc Young Adult Oncol 10:193–201. https://doi.org/10.1089/jayao.2020.0100

    Article  PubMed  Google Scholar 

  25. Jing CY et al (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. Clin Med Insights Oncol 16:11795549221110522. https://doi.org/10.1177/11795549221110522

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kim YB, Holschneider CH, Ghosh K, Nieberg RK, Montz FJ (1997) Progestin alone as primary treatment of endometrial carcinoma in premenopausal women report of seven cases and review of the literature. Cancer 79:320–327

    Article  CAS  PubMed  Google Scholar 

  27. Guillon S, Popescu N, Phelippeau J, Koskas M (2019) A systematic review and meta-analysis of prognostic factors for remission in fertility-sparing management of endometrial atypical hyperplasia and adenocarcinoma. Int J Gynaecol obstetrics 146:277–288. https://doi.org/10.1002/ijgo.12882

    Article  Google Scholar 

  28. Park JY et al (2013) Pregnancy outcomes after fertility-sparing management in young women with early endometrial cancer. Obstet Gynecol 121:136–142. https://doi.org/10.1097/aog.0b013e31827a0643

    Article  PubMed  Google Scholar 

  29. Chen M et al (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 132:34–38. https://doi.org/10.1016/j.ijgo.2015.06.046

    Article  PubMed  Google Scholar 

  30. Zhao XL et al (2021) Fertility-preserving treatment in patients with early-stage endometrial cancer: a protocol for systematic review and meta-analysis. Medicine 100:e27961. https://doi.org/10.1097/md.0000000000027961

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Park H, Seong SJ, Yoon BS (2011) The effect of operative hysteroscopy conducted before progestin treatment in early stage endometrial cancer from the view of fertility. Gynecol Oncol 123:427–428. https://doi.org/10.1016/j.ygyno.2011.01.012

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Obstetrics and Gynecology Department, LiShui City People’s Hospital, No. 1188, Liyang Street, Lishui City, 323000, Zhejiang Province, China

    Xiabin Ye & Tonghuai Li

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  1. Xiabin Ye
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XY: provision of study materials or patients, collection and assembly of data, data analysis and interpretation, manuscript writing, final approval of manuscript. TL: conception and design, administrative support, manuscript writing, final approval of manuscript.

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Correspondence to Tonghuai Li.

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Ye, X., Li, T. Effects of hysteroscopic surgery combined with progesterone therapy on fertility and prognosis in patients with early endometrial cancer and atypical endometrial hyperplasia or endometrial intraepithelial neoplasia: a meta-analysis. Arch Gynecol Obstet 309, 259–268 (2024). https://doi.org/10.1007/s00404-023-07173-8

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