高分化早期子宫内膜癌和复杂性不典型增生保留生育功能治疗方法的比较。
Comparison among fertility-sparing therapies for well differentiated early-stage endometrial carcinoma and complex atypical hyperplasia.
作者信息
Zhang Qing, Qi Gonghua, Kanis Margaux J, Dong Ruifen, Cui Baoxia, Yang Xingsheng, Kong Beihua
机构信息
Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, Shandong, 250012, P.R. China.
Gynecology Oncology Key Laboratory, Qilu Hospital, Shandong University, Ji'nan, Shandong, 250012, P.R. China.
出版信息
Oncotarget. 2017 May 3;8(34):57642-57653. doi: 10.18632/oncotarget.17588. eCollection 2017 Aug 22.
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% < 0.0001) and live birth rate (52.57% vs 33.38%, = 0.0944) and a lower recurrence rate compared with oral progestogens alone (4.79% vs 32.17% = 0.0004). At the same time, the pooled live birth rate (52.57% vs 18.09% =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%; = 0.4098) and recurrence rates (4.79% vs 3.90% = 0.8561) was seen.
CONCLUSIONS
Of the available fertility-sparing therapeutic options, HR followed by progestogens may be a more effective one.
目的
比较包括口服孕激素、宫腔镜切除术（HR）和左炔诺孕酮宫内节育系统（LNG-IUS）在内的保留生育功能疗法在高分化早期子宫内膜癌（eEC）和复杂性非典型增生（CAH）患者中实现疾病消退、复发及活产率的情况。
研究设计
这是一项对既往关于高分化早期子宫内膜癌（eEC）和复杂性非典型增生（CAH）保留生育功能疗法研究的荟萃分析。
数据来源
检索了Medline、Cochrane图书馆和Embase，检索词及同义词为：与eEC和CAH相似的词汇以及与保留生育功能相关的疗法。
主要观察指标
从每项研究中提取接受保留生育功能疗法的所有患者数量、病情消退、复发及分娩的患者数量，并计算每项研究的消退率、复发率和活产率。借助R语言中“meta”和“meta for”软件包中的meta回归比较每两种干预措施之间的消退率、复发率和活产率。
结果
纳入了54项报告高分化早期子宫内膜癌（eEC）和复杂性非典型增生（CAH）年轻女性保留生育功能疗法的研究。荟萃分析显示，与单纯口服孕激素相比，HR联合孕激素治疗后的综合消退率更高（98.06%对77.20%，<0.0001），活产率更高（52.57%对33.38%，=0.0944），复发率更低（4.79%对32.17%，=0.0004）。同时，HR联合孕激素治疗后的综合活产率（52.57%对18.09%，=0.0399）显著高于单纯LNG-IUS。两者在消退率（98.06%对94.24%；=0.4098）和复发率（4.79%对3.90%，=0.8561）方面无统计学差异。
结论
在现有的保留生育功能治疗方案中，HR联合孕激素可能是更有效的一种。
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