Li Miaomiao, Guo Tao, Cui Ran, Feng Ying, Bai Huimin, Zhang Zhenyu
Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China.
Cancer Manag Res. 2019 May 6;11:4005-4021. doi: 10.2147/CMAR.S194607. eCollection 2019.
This study aimed to identify potential prognostic factors for patients with complex atypical hyperplasia (CAH) or early-stage endometrial cancer (EC) who received progestin therapy to spare fertility and, thus, improve the management of this patient group. The PubMed, PMC, EMBASE, Web of Science, and Cochrane databases were searched for correlational studies published in English. Studies that evaluated the prognosis of patients with CAH or early-stage EC were pooled for a systematic review and meta-analysis. In total, 31 eligible studies, including 8 prospective and 23 retrospective studies involving 1099 patients, were included in this analysis. The most commonly used progestin agents were medroxyprogesterone acetate (MPA, 47.0%) and megestrol acetate (MA, 25.5%). The total complete response (CR) rate was 75.8% (833/1099), and the median time to CR with first-line progestin therapy was 6 months. In total, 294 (26.8%) patients who achieved CR became pregnant spontaneously (28 cases) or through assisted reproductive technology (127 cases). During the median follow-up of 39 months, 245 (22.3%) women developed recurrence. Only one patient (0.09%) died of the disease. The meta-analysis showed that compared to a BMI<25 kg/m and CAH, a body mass index (BMI) ≥25 kg/m (=0.0004, odds ratios (OR), 0.4; 95% confidence interval, 0.3-0.6) and EC (=0.0000, OR, 0.3; 95% confidence interval, 0.2-0.6) were significantly associated with a higher likelihood of a CR. Patients with a BMI≥25 kg/m (=0.0007, OR, 2.5; 95% confidence interval, 1.4-4.3), PCOS (=0.0006, OR, 3.4; 95% confidence interval, 1.5-7.9), and EC (=0.0344, OR, 2.8; 95% confidence interval, 1.4-5.3) had a significantly higher risk of recurrence. In general, patients with CAH or early-stage EC who were treated with progesterone therapy had a favorable prognosis. However, the recurrence risk was not insignificant. Weight control is crucial for improving the clinical management of this patient group.
本研究旨在确定接受孕激素治疗以保留生育功能的复杂非典型增生（CAH）或早期子宫内膜癌（EC）患者的潜在预后因素，从而改善该患者群体的管理。通过检索PubMed、PMC、EMBASE、Web of Science和Cochrane数据库，查找以英文发表的相关性研究。对评估CAH或早期EC患者预后的研究进行汇总，以进行系统评价和荟萃分析。本分析共纳入31项符合条件的研究，包括8项前瞻性研究和23项回顾性研究，涉及1099例患者。最常用的孕激素制剂是醋酸甲羟孕酮（MPA，47.0%）和醋酸甲地孕酮（MA，25.5%）。总完全缓解（CR）率为75.8%（833/1099），一线孕激素治疗至CR的中位时间为6个月。共有294例（26.8%）达到CR的患者自然怀孕（28例）或通过辅助生殖技术怀孕（127例）。在中位随访39个月期间，245例（22.3%）女性出现复发。只有1例患者（0.09%）死于该疾病。荟萃分析表明，与BMI<25kg/m及CAH相比，体重指数（BMI）≥25kg/m（P=0.0004，比值比（OR）为0.4；95%置信区间为0.3 - 0.6）和EC（P=0.0000，OR为0.3；95%置信区间为0.2 - 0.6）与CR可能性较高显著相关。BMI≥25kg/m（P=0.0007，OR为2.5；95%置信区间为1.4 - 4.3）、多囊卵巢综合征（PCOS，P=0.0006，OR为3.4；95%置信区间为1.5 - 7.9）和EC（P=0.0344，OR为2.8；95%置信区间为1.4 - 5.3）的患者复发风险显著更高。总体而言，接受孕激素治疗的CAH或早期EC患者预后良好。然而，复发风险并非微不足道。体重控制对于改善该患者群体的临床管理至关重要。
