Queensland University of Technology, Queensland, Australia.
Gynecol Oncol. 2012 Apr;125(1):263-70. doi: 10.1016/j.ygyno.2011.11.043. Epub 2011 Dec 3.
To investigate the efficacy of progestin treatment to achieve pathological complete response (pCR) in patients with complex atypical endometrial hyperplasia (CAH) or early endometrial adenocarcinoma (EC).
A systematic search identified 3245 potentially relevant citations. Studies containing less than ten eligible CAH or EC patients in either oral or intrauterine treatment arm were excluded. Only information from patients receiving six or more months of treatment and not receiving other treatments was included. Weighted proportions of patients achieving pCR were calculated using R software.
Twelve studies met the selection criteria. Eleven studies reported treatment of patients with oral (219 patients, 117 with CAH, 102 with grade 1 Stage I EC) and one reported treatment of patients with intrauterine progestin (11 patients with grade 1 Stage IEC). Overall, 74% (95% confidence interval [CI] 65-81%) of patients with CAH and 72% (95% CI 62-80%) of patients with grade 1 Stage I EC achieved a pCR to oral progestin. Disease progression whilst on oral treatment was reported for 6/219 (2.7%), and relapse after initial complete response for 32/159 (20.1%) patients. The weighted mean pCR rate of patients with grade 1 Stage I EC treated with intrauterine progestin from one prospective pilot study and an unpublished retrospective case series from the Queensland Centre of Gynaecologic Oncology (QCGC) was 68% (95% CI 45-86%).
There is a lack of high quality evidence for the efficacy of progestin in CAH or EC. The available evidence however suggests that treatment with oral or intrauterine progestin is similarly effective. The risk of progression during treatment is small but longer follow-up is required. Evidence from prospective controlled clinical trials is warranted to establish how the efficacy of progestin for the treatment of CAH and EC can be improved further.
研究孕激素治疗复杂性非典型子宫内膜增生（CAH）或早期子宫内膜腺癌（EC）患者达到病理完全缓解（pCR）的疗效。
系统检索确定了 3245 篇潜在相关文献。排除了口服或宫内治疗组中 CAH 或 EC 患者少于 10 例的研究。仅纳入接受 6 个月以上治疗且未接受其他治疗的患者信息。使用 R 软件计算达到 pCR 的患者的加权比例。
符合选择标准的 12 项研究。11 项研究报告了口服孕激素治疗患者（219 例，117 例 CAH，102 例Ⅰ期 EC Ⅰ级）的情况，1 项研究报告了宫内孕激素治疗患者（11 例Ⅰ期 EC Ⅰ级）的情况。总体而言，CAH 患者中 74%（95%置信区间 65-81%）和Ⅰ期 EC Ⅰ级患者中 72%（95%置信区间 62-80%）达到了口服孕激素的 pCR。117 例 CAH 患者中有 6 例（2.7%）在口服治疗过程中出现疾病进展，159 例初始完全缓解患者中有 32 例（20.1%）复发。一项前瞻性试点研究和昆士兰妇科肿瘤中心（QCGC）未发表的回顾性病例系列报告的 11 例Ⅰ期 EC Ⅰ级患者的宫内孕激素治疗的加权平均 pCR 率为 68%（95%置信区间 45-86%）。
孕激素治疗 CAH 或 EC 的疗效缺乏高质量证据。然而，现有证据表明，口服或宫内孕激素治疗同样有效。治疗过程中进展的风险较小，但需要更长时间的随访。需要前瞻性对照临床试验的证据来确定如何进一步提高孕激素治疗 CAH 和 EC 的疗效。
