Division of Gynecologic Oncology, Bichat University Hospital, Paris Diderot University, Paris, France.
Int J Gynaecol Obstet. 2019 Sep;146(3):277-288. doi: 10.1002/ijgo.12882. Epub 2019 Jul 15.
Endometrial cancer and atypical hyperplasia are rare in young women but create a dilemma between desire for pregnancy and oncologic outcomes.
To identify remission rates and associated prognostic factors in patients undergoing fertility-sparing management for endometrial cancer and atypical hyperplasia.
MEDLINE was searched for studies published between January 1, 1950 and July 31, 2017 using various search terms.
Studies evaluating fertility-sparing management in patients aged between 19 and 44 years with atypical hyperplasia or stage I endometrial cancer.
Use of PRISMA guidelines to conduct a meta-analysis of the proportion of patients in remission and meta-regression analysis to test the effect of possible prognostic factors for remission.
A total of 3673 studies were screened; 65 studies including 1604 patients met the inclusion criteria. The remission rate was 0.75 (95% CI, 0.73-0.77). Operative hysteroscopy for endometrial sampling was associated with higher remission rates (OR 2.31; 95% CI, 1.10-4.84; P=0.03). Studies with higher ratios of infertile women were associated with higher remission rates (OR 4.21; 95% CI, 1.44-12.33; P<0.01).
Operative hysteroscopy is the preferred endometrial sampling method for patients with atypical hyperplasia or endometrial cancer undergoing fertility-sparing management.
子宫内膜癌和非典型增生在年轻女性中较为罕见，但在患者渴望妊娠与肿瘤学结局之间造成了困境。
明确行保留生育功能治疗的子宫内膜癌和非典型增生患者的缓解率及其相关预后因素。
使用多种检索词，检索 1950 年 1 月 1 日至 2017 年 7 月 31 日期间发表的 MEDLINE 文献。
评估年龄在 19 至 44 岁之间、患有非典型增生或 I 期子宫内膜癌的患者行保留生育功能治疗的研究。
使用 PRISMA 指南对缓解患者的比例进行荟萃分析，并进行荟萃回归分析以检验缓解的可能预后因素的作用。
共筛选出 3673 项研究，其中 65 项研究（包括 1604 例患者）符合纳入标准。缓解率为 0.75（95%CI，0.73-0.77）。手术性宫腔镜子宫内膜取样与更高的缓解率相关（OR 2.31；95%CI，1.10-4.84；P=0.03）。不孕女性比例较高的研究与更高的缓解率相关（OR 4.21；95%CI，1.44-12.33；P<0.01）。
对于行保留生育功能治疗的非典型增生或子宫内膜癌患者，手术性宫腔镜是首选的子宫内膜取样方法。
