Research
General gynecology
Regression, relapse, and live birth rates with fertility-sparing therapy for endometrial cancer and atypical complex endometrial hyperplasia: a systematic review and metaanalysis

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Objective

The objective of the study was to evaluate the regression, relapse, and live birth rates of early-stage endometrial cancer (EC) and atypical complex hyperplasia (ACH) with fertility-sparing treatment.

Study Design

This was a metaanalysis of the proportions from observational studies with a random-effects model and a meta-regression to explore for heterogeneity.

Results

Thirty-four observational studies, evaluating the regression, relapse, and live birth rates of early-stage EC (408 women) and ACH (151 women) with fertility-sparing treatment. Fertility-sparing treatment for EC achieved a pooled regression rate of 76.2%, a relapse rate of 40.6%, and a live birth rate of 28%. For ACH the pooled regression rate was 85.6%, a relapse rate of 26%, and a live birth rate of 26.3%. Twenty women were diagnosed with ovarian cancer (concurrent or metastatic) during follow-up (3.6%) and 10 progressed to higher than stage I EC (1.9%) from which 2 women died.

Conclusion

Fertility-sparing treatment of EC and ACH is feasible and selected women can satisfy their reproductive wishes.

Section snippets

Identification of literature

The population of interest in this systematic review was women with early clinical stage (International Federation of Gynecology and Obstetrics stage I) EC or ACH, the intervention was fertility-sparing therapies, and the outcome was evidence of disease regression, relapse, and live births. The following electronic databases were searched: MEDLINE (1950 to September 2011), EMBASE (1980 to September 2011), Cochrane Central Register of Controlled Trials and Web of Science conference proceedings

Selection, characteristics and quality of the primary studies

The electronic search strategy yielded 9516 citations, and we retrieved a further 10 citations from our manual checking of reference lists of all primary articles. Of these, 9477 citations were excluded because they did not fulfill the selection criteria. Examination of the full text of the remaining 54 manuscripts found a total of 34 primary studies,12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45 including

Comment

This metaanalysis, which included 408 women with EC and 151 with ACH, found that the regression rates with fertility-sparing treatment are very encouraging (76% for EC and 86% for ACH). An additional encouraging proportion of women choosing this treatment for preserving their fertility managed to achieve live births (28% of women with EC and 26% of women with ACH). Women choosing assisted reproductive treatment had significantly better results, regardless of the initial diagnosis. However, the

Acknowledgment

We thank Wilma Arnold for her administrative support.

References (48)

  • J.F. Le Digabel et al.

    [Young women with atypical endometrial hyperplasia or endometrial adenocarcinoma stage I: will conservative treatment allow pregnancy? Results of a French multicentric survey]

    Gynecol Obstet Fertil

    (2006)
  • H.Z. Li et al.

    Letrozole as primary therapy for endometrial hyperplasia in young women

    Int J Gynaecol Obstet

    (2008)
  • Y. Mao et al.

    Outcomes of conservative therapy for young women with early endometrial adenocarcinoma

    Fertil Steril

    (2010)
  • I. Mazzon et al.

    Conservative surgical management of stage IA endometrial carcinoma for fertility preservation

    Fertil Steril

    (2010)
  • T. Minaguchi et al.

    Combined phospho-Akt and PTEN expressions associated with post-treatment hysterectomy after conservative progestin therapy in complex atypical hyperplasia and stage Ia, G1 adenocarcinoma of the endometrium

    Cancer Lett

    (2007)
  • L. Minig et al.

    Progestin intrauterine device and GnRH analogue for uterus-sparing treatment of endometrial precancers and well-differentiated early endometrial carcinoma in young women

    Ann Oncol

    (2011)
  • F.J. Montz et al.

    Intrauterine progesterone treatment of early endometrial cancer

    Am J Obstet Gynecol

    (2002)
  • T.C. Randall et al.

    Progestin treatment of atypical hyperplasia and well-differentiated carcinoma of the endometrium in women under age 40

    Obstet Gynecol

    (1997)
  • Y.C. Yang et al.

    Reevaluating the safety of fertility-sparing hormonal therapy for early endometrial cancer

    Gynecol Oncol

    (2005)
  • L. Chiva et al.

    Sparing fertility in young patients with endometrial cancer

    Gynecol Oncol

    (2008)
  • Cancer Statistics registrations: registrations of cancer diagnosed in 2007, EnglandNational Statistics (Series MB1 no. 38)

    (2010)
  • L.G. Escobedo et al.

    Infertility-associated endometrial cancer risk may be limited to specific subgroups of infertile women

    Obstet Gynecol

    (1991)
  • Classification of endometrial hyperplasia

  • K. Slim et al.

    Methodological index for non-randomized studies (minors): development and validation of a new instrument

    ANZ J Surg

    (2003)
  • This study and I.D.G. were supported through a Wellbeing of Women entry-level scholarship (ELS022).

    The authors report no conflict of interest.

    Cite this article as: Gallos ID, Yap J, Rajkhowa M, et al. 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 2012;207;266.e1-12.

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