Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
Front Endocrinol (Lausanne). 2023 Jun 21;14:1139858. doi: 10.3389/fendo.2023.1139858. eCollection 2023.
Progestin based therapy is the preferred option for fertility-sparing treatment of reproductive-age women with preserved fertility in endometrial hyperplasia (EH) or early endometrial cancer (EEC). Our objective was to investigate whether metformin could enhance the efficacy of progestin-based therapies by meta-analysis.
We conducted a meta-analysis of randomized or non-randomized controlled trials by searching of PubMed, Embase, Web of science, and Cochrane database from inception to November 8, 2022. The results of enrolled studies were pooled using meta-analysis to estimate the effect of progestin plus metformin on remission, recurrence, pregnancy rate and live birth rate.
In the analysis of progestin administered systemically or locally, complete response (CR) was significantly higher in progestin plus metformin versus progestin alone in the EH group (pooled OR 2.08, 95% CI 1.29 to 3.34, P=0.003), in the EEC group (pooled OR 1.86, 95% CI 1.13 to 3.05, P=0.01), but not in EEC and EH group (pooled OR 1.46, 95% CI 0.97 to 2.21, P=0.07). In the analysis of progestin administered systemically, complete response was improved in progestin plus metformin versus progestin alone, in the EH group (pooled OR 2.47, 95% CI 1.45 to 4.21, P=0.0009), in the EEC group (pooled OR 2.09, 95% CI 1.18 to 3.71, P=0.01), and in the EEC and EH group (pooled OR 2.03, 95% CI 1.16 to 3.54, P=0.01). The relapse rates of patients with EEC and EH were not different (pooled OR 0.54, 95% CI 0.24 to 1.20, P=0.13). For obstetric outcomes, the addition of metformin improved pregnancy rate (pooled OR 1.55, 95% CI 0.99 to 2.42, P=0.05), but not live birth rate (pooled OR 0.95, 95% CI 0.45 to 2.01, P=0.89).
For fertility-sparing management, compared to progestin alone, the outcomes of patients with endometrial hyperplasia and early endometrial cancer were more improved with progestin plus metformin because progestin plus metformin increases the rate of remission and pregnancy.
孕激素为基础的治疗是保留生育功能的首选方案，适用于有生育要求的子宫内膜增生（EH）或早期子宫内膜癌（EEC）患者。我们的目的是通过荟萃分析研究二甲双胍是否可以增强孕激素为基础的治疗效果。
我们检索了 PubMed、Embase、Web of science 和 Cochrane 数据库，从建库到 2022 年 11 月 8 日，对随机或非随机对照试验进行了荟萃分析。使用荟萃分析汇总纳入研究的结果，以估计孕激素加二甲双胍对缓解率、复发率、妊娠率和活产率的影响。
在系统或局部给予孕激素的分析中，与单独使用孕激素相比，孕激素加二甲双胍在 EH 组（合并 OR 2.08，95%CI 1.29 至 3.34，P=0.003）、EEC 组（合并 OR 1.86，95%CI 1.13 至 3.05，P=0.01）中完全缓解（CR）率更高，但在 EEC 和 EH 组中无显著差异（合并 OR 1.46，95%CI 0.97 至 2.21，P=0.07）。在系统给予孕激素的分析中，与单独使用孕激素相比，孕激素加二甲双胍在 EH 组（合并 OR 2.47，95%CI 1.45 至 4.21，P=0.0009）、EEC 组（合并 OR 2.09，95%CI 1.18 至 3.71，P=0.01）和 EEC 和 EH 组（合并 OR 2.03，95%CI 1.16 至 3.54，P=0.01）中 CR 率更高。EH 和 EEC 患者的复发率无显著差异（合并 OR 0.54，95%CI 0.24 至 1.20，P=0.13）。对于产科结局，二甲双胍的添加提高了妊娠率（合并 OR 1.55，95%CI 0.99 至 2.42，P=0.05），但未提高活产率（合并 OR 0.95，95%CI 0.45 至 2.01，P=0.89）。
对于保留生育功能的管理，与单独使用孕激素相比，孕激素加二甲双胍可提高子宫内膜增生和早期子宫内膜癌患者的缓解率和妊娠率。
