Fernandez-Montoli Maria-Eulalia, Sabadell Jordi, Contreras-Perez Nayanar-Adela
Department of Gynaecology, Hospital Universitari de Bellvitge, Universitat de Barcelona-IDIBELL, Barcelona, Spain.
Department of Gynaecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain.
Adv Ther. 2021 May;38(5):2717-2731. doi: 10.1007/s12325-021-01693-y. Epub 2021 Apr 8.
Endometrial cancer is the fifth most common cancer in women and atypical endometrial hyperplasia is a precancerous lesion. Obesity is an important risk factor for endometrioid endometrial adenocarcinoma and endometrial hyperplasia. Progesterone is recommended as first-line treatment in endometrial cancer or atypical endometrial hyperplasia in women who wish to preserve fertility, but optimal treatment schedules have not been defined. Metformin or bariatric surgery may also be useful in these women. The effectiveness and safety of fertility-preserving treatments being used for women with atypical endometrial hyperplasia and stage IA grade 1 endometrial cancer is unclear. Therefore, the systematic review aims to determine this point.
We will search the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, trial registers, conference proceedings, abstracts, cooperative trial groups and reference lists. We will include randomised controlled trials (RCTs) that compare fertility-preserving therapy including orally administered progesterone versus a levonorgestrel-releasing intrauterine system (IUS), metformin, other pharmacological interventions or bariatric surgery, and any of these interventions with womb-removing surgery. Quasi-randomised trials, non-randomised trials and cohort studies will be included. Two review authors will independently assess study eligibility and risk of bias and extract data. The primary outcomes are complete pathologic response and live birth rate. Secondary outcomes include overall survival, progression-free survival, pregnancy rate, need for hysterectomy, adverse events, psychological symptoms and quality of life.
This review aims to clarify the effectiveness and risks of fertility-preserving treatments, including complete pathologic response rate, live birth rates, need for surgical treatment, adverse events, psychological symptoms and quality of life. The broad scope of the review includes the use of progesterone, metformin to reverse insulin resistance, and bariatric surgery or operative hysteroscopy.
The results may help to determine the optimal fertility-sparing treatment in endometrial cancer and atypical endometrial hyperplasia.
Prospero 2019 number CRD42019145991.
子宫内膜癌是女性中第五大常见癌症，非典型子宫内膜增生是一种癌前病变。肥胖是子宫内膜样腺癌和子宫内膜增生的重要危险因素。对于希望保留生育能力的子宫内膜癌或非典型子宫内膜增生女性，推荐孕激素作为一线治疗，但尚未确定最佳治疗方案。二甲双胍或减肥手术对这些女性可能也有用。用于非典型子宫内膜增生和IA期1级子宫内膜癌女性的保留生育功能治疗的有效性和安全性尚不清楚。因此，本系统评价旨在确定这一点。
我们将检索Cochrane对照试验中心注册库（CENTRAL）、MEDLINE、Embase、试验注册库、会议论文集、摘要、合作试验组和参考文献列表。我们将纳入比较保留生育功能治疗的随机对照试验（RCT），包括口服孕激素与左炔诺孕酮宫内节育系统（IUS）、二甲双胍、其他药物干预或减肥手术，以及这些干预措施中的任何一种与子宫切除术。将纳入半随机试验、非随机试验和队列研究。两位综述作者将独立评估研究的纳入资格和偏倚风险并提取数据。主要结局是完全病理缓解率和活产率。次要结局包括总生存期、无进展生存期、妊娠率、子宫切除需求、不良事件、心理症状和生活质量。
本综述旨在阐明保留生育功能治疗的有效性和风险，包括完全病理缓解率、活产率、手术治疗需求、不良事件、心理症状和生活质量。综述的广泛范围包括孕激素、二甲双胍逆转胰岛素抵抗、减肥手术或宫腔镜手术的使用。
结果可能有助于确定子宫内膜癌和非典型子宫内膜增生的最佳保留生育功能治疗方法。
国际系统评价前瞻性注册库（Prospero）2019年编号CRD42019145991 。
