Int J Gynecol Cancer. 2018 Feb;28(2):385-393. doi: 10.1097/IGC.0000000000001164.
The aim of this study was to investigate the different efficacies of various fertility-preserving therapies for grade 1 presumed stage IA endometrial cancer.
We searched the major online databases (PubMed, MEDLINE, Cochrane Library, Web of Science, and Ovid) and retrieved all the research on fertility-preserving treatment for young, grade 1 presumed stage IA endometrial adenocarcinoma patients since January 2000. We used the systemic evaluation of the Cochrane Collaboration to select the literature and merge the data we collected using R3.2.2 software (R Development Core Team, Auckland, New Zealand). By comparing the remission, recurrence, and pregnancy rates, we evaluated the efficiency of 3 existing fertility-preserving treatments indirectly: a) taking oral progestin only therapy, b) hysteroscopic resection followed by progestin therapy, and c) intrauterine progestin therapy: levonorgestrel-releasing intrauterine system combined with gonadotropin-releasing hormone agonist/progestin therapy.
Twenty-eight studies met the selection criteria. A total of 619 cases were included in this study. The group that took oral progestin only (456 patients) achieved a complete remission rate (CRR), recurrence rate (ReR), and pregnancy rate (PregR) of 76.3%, (95% confidence interval [CI], 70.7%-81.1%); 30.7% (95% CI, 21.0%-42.4%); and 52.1% (95% CI, 41.2%-66.0%), respectively. The hysteroscopic resection followed by progestin therapy group (73 patients) achieved a CRR, ReR, and PregR of 95.3% (95% CI, 87.8%-100%); 14.1% (95% CI, 7.1%-26.1%); and 47.8% (95% CI, 33.0%-69.5%), respectively. The intrauterine progestin therapy group (90 patients) achieved a CRR, ReR, and PregR of 72.9% (95% CI, 60.4%-82.5%); 11.0% (95% CI, 5.1%-22.0%); and 56.0% (95% CI, 37.3%-73.1%), respectively.
The existing results show that patients who received hysteroscopic resection followed by progestin therapy achieved the highest CRR. Patients who received oral progestin only might be more likely to recur and have more systemic adverse effects. Recent intrauterine progestin therapy such as levonorgestrel-releasing intrauterine system combined with gonadotropin-release hormone receptor agonist/progestin have a satisfactory PregR and low ReR rate. Considering the inherent limitations of the studies we included, further well-designed, randomized controlled trials are necessary to confirm and update this analysis.
本研究旨在探讨不同的保留生育功能疗法对 1 级疑似 IA 期子宫内膜癌的疗效。
我们检索了主要的在线数据库（PubMed、MEDLINE、Cochrane 图书馆、Web of Science 和 Ovid），检索了 2000 年 1 月以来所有关于年轻、1 级疑似 IA 期子宫内膜腺癌患者保留生育功能治疗的研究。我们使用 Cochrane 协作组织的系统评价来选择文献，并使用 R3.2.2 软件（奥克兰，新西兰，R 发展核心小组）合并我们收集的数据。通过比较缓解率、复发率和妊娠率，我们间接评估了 3 种现有的保留生育功能治疗的效率：a）口服孕激素治疗，b）宫腔镜下切除后孕激素治疗，c）宫内孕激素治疗：左炔诺孕酮释放宫内系统联合促性腺激素释放激素激动剂/孕激素治疗。
符合选择标准的 28 项研究。共有 619 例患者纳入本研究。接受口服孕激素治疗的 456 例患者的完全缓解率（CRR）、复发率（ReR）和妊娠率（PregR）分别为 76.3%（95%置信区间[CI]，70.7%-81.1%）、30.7%（95% CI，21.0%-42.4%）和 52.1%（95% CI，41.2%-66.0%）。宫腔镜下切除后孕激素治疗组（73 例）的 CRR、ReR 和 PregR 分别为 95.3%（95% CI，87.8%-100%）、14.1%（95% CI，7.1%-26.1%）和 47.8%（95% CI，33.0%-69.5%）。宫内孕激素治疗组（90 例）的 CRR、ReR 和 PregR 分别为 72.9%（95% CI，60.4%-82.5%）、11.0%（95% CI，5.1%-22.0%）和 56.0%（95% CI，37.3%-73.1%）。
现有结果表明，接受宫腔镜下切除后孕激素治疗的患者获得了最高的 CRR。接受口服孕激素治疗的患者更有可能复发，且全身不良反应更多。最近的宫内孕激素治疗，如左炔诺孕酮释放宫内系统联合促性腺激素释放激素受体激动剂/孕激素治疗，具有满意的妊娠率和较低的复发率。考虑到我们纳入的研究存在固有局限性，需要进一步设计良好的随机对照试验来证实和更新本分析。
