Comparison among fertility-sparing therapies for well differentiated early-stage endometrial carcinoma and complex atypical hyperplasia

// Qing Zhang 1, 2, * , Gonghua Qi 1, 4, * , Margaux J. Kanis 3 , Ruifen Dong 1 , Baoxia Cui 1 , Xingsheng Yang 1 and Beihua Kong 1, 2 1 Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji’nan, Shandong, 250012, P.R. China 2 Gynecology Oncology Key Laboratory, Qilu Hospital, Shandong University, Ji’nan, Shandong, 250012, P.R. China 3 Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA 4 School of Medicine, Shandong University, Ji’nan, Shandong, 250012, P.R. China * These authors contributed equally to this work Correspondence to: Beihua Kong, email: kongbeihua@sdu.edu.cn Keywords: endometrial carcinoma, complex atypical hyperplasia, fertility-sparing therapy, hysteroscopic resection, oral progestogens Received: December 15, 2016      Accepted: April 05, 2017      Published: May 03, 2017 ABSTRACT Objective: To compare fertility-sparing therapies including oral progestogens, hysteroscopic resection (HR), and the levonorgestrel- releasing intrauterine system (LNG-IUS) in achieving disease regression, recurrence and live birth rate in well differentiate early-stage endometrial carcinoma (eEC) and complex atypical hyperplasia(CAH). Study Design: This was a meta-analysis of previous studies focus on the fertility-sparing therapy for well differentiate early-stage endometrial carcinoma (eEC) and complex atypical hyperplasia (CAH). Date Sources: Medline, the Cochrane Library and Embase was searched with the terms and Synonyms: words similar to eEC and CAH with therapies associated with fertility-sparing. Main Outcome Measures: The number of all patients accepted fertility sparing therapies, patients got regressed, relapsed and delivered were extracted from each study, and the regression, recurrence, and live birth rate of each study were calculated. The regression, recurrence and live birth rates between each two interventions were compared with the aid of meta-regression in packages of “meta” and ”meta for” written in R. Results: Fifty-four studies reported fertility sparing therapies in young women with eEC and CAH were included. Meta-analysis showed that HR followed by progestogens achieved a higher pooled regression (98.06% vs 77.20% P < 0.0001) and live birth rate (52.57% vs 33.38%, P = 0.0944) and a lower recurrence rate compared with oral progestogens alone (4.79% vs 32.17% P = 0.0004). At the same time, the pooled live birth rate (52.57% vs 18.09% P =0.0399) of HR followed by progestogens are significantly higher than the LNG-IUS alone. Which no statistical difference in regression (98.06% vs 94.24%; P = 0.4098) and recurrence rates (4.79% vs 3.90% P = 0.8561) was seen. Conclusions: Of the available fertility-sparing therapeutic options, HR followed by progestogens may be a more effective one.