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

Abstract

ObjectiveTo 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 DesignThis 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 SourcesMedline, 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 MeasuresThe 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.ResultsFifty-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.ConclusionsOf the available fertility-sparing therapeutic options, HR followed by progestogens may be a more effective one.

Endometrial hyperplasia and the risk of coexistent cancer: WHO versus EIN criteria

“…This might imply that >10% of precancerous EHs are undertreated, increasing the risk of progression to cancer. The conservative treatment of premalignant EH has shown excellent outcomes, particularly with hysteroscopic resection and/or medicated intrauterine devices . Therefore, a highly sensitive diagnostic method, such as the EIN system, may be more appropriate than the WHO system for the initial identification of women who need to be treated.…”

“…The conservative treatment of premalignant EH has shown excellent outcomes, particularly with hysteroscopic resection and/or medicated intrauterine devices. [38][39][40] Therefore, a highly sensitive diagnostic method, such as the EIN system, may be more appropriate than the WHO system for the initial identification of women who need to be treated. On the other hand, the WHO system showed higher specificity than the EIN system in predicting the risk of coexistent cancer.…”

Diagnostic and prognostic value of ARID1A in endometrial hyperplasia: a novel marker of occult cancer

“…Given all these observations, ARID1A evaluation may add important diagnostic and prognostic information in order to adopt a more tailored approach to the patient. Such information may be even more important if we consider the wide range of available treatments for EH ad EC and the inaccuracy of the predictive markers studied . To date, ARID1A appears as the most promising prognostic marker in EH.…”

Complexity of glandular architecture should be reconsidered in the classification and management of endometrial hyperplasia

“…Progression rates might also vary based on the patient management (i.e., whether or not the patient was treated before hysterectomy; which type of progestin was administered; whether or not hysteroscopic resection was performed) .…”

“…Progression rates might also vary based on the patient management (i.e., whether or not the patient was treated before hysterectomy; which type of progestin was administered; whether or not hysteroscopic resection was performed) (6,7). Furthermore, the low reproducibility of the diagnosis of EH and its morphologic parameters (architecture complexity, nuclear atypia) might be a major limitation, despite being intrinsic to the topic assessed (25).…”