Ronsini Carlo, Romeo Paola, Andreoli Giada, Palmara Vittorio, Palumbo Marco, Caruso Giuseppe, De Franciscis Pasquale, Vizzielli Giuseppe, Restaino Stefano, Chiantera Vito, Cianci Stefano
Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
Unit of Gynecology and Obstetrics, Department of Human Pathology of Adult and Childhood "G. Barresi", University of Messina, 98121 Mesina, Italy.
Medicina (Kaunas). 2025 Mar 7;61(3):471. doi: 10.3390/medicina61030471.
Endometrial cancer (EC) affects 3-14% of women under 40 who wish to preserve their fertility. The standard treatment for EC is a hysterectomy with salpingo-oophorectomy. However, for those desiring fertility preservation, oral progestogens such as medroxy-progesterone acetate (MPA) or megestrol acetate (MA) are the most common therapies in Fertility-Sparing Treatment (FST). Other treatments include gonadotropin-releasing hormone agonist (GnRHa), levonorgestrel-releasing intrauterine system (LNG-IUS), and metformin plus progestin. This comprehensive review evaluates the best FST options for women with reproductive potential. PubMed, EMBASE, and Scopus were searched in June 2023 using specific keywords. Studies included in the review focused on patients with EC undergoing FST, with outcomes such as complete response rate (CRR), recurrence rate (RR), pregnancy rate (PR), and live birth rate. Eighteen studies met the inclusion criteria, involving 23,976 patients. In only-oral progestin trials, CRR ranged from 18% to 100%; RR ranged from 0% to 81.8%; Death Rate ranged from 0% to 3.6%. In studies combining oral progestin with LNG-IUS, CRR ranged from 55% to 87.5%; RR ranged from 0% to 41.7%; Death Rate was 0%. Most patients with Stage IA EC received MPA or MA. Fertility-related outcomes were reported in 15 studies. PR ranged from 4 to 44 patients in trials involving only oral progestins. When combining oral progestin with LNG-IUS, PR ranged from 1 to 46 patients. Progestin therapy, including oral MPA and MA, is considered safe and effective, with limited evidence supporting the use of LNG-IUS.
子宫内膜癌（EC）影响着3%至14%希望保留生育能力的40岁以下女性。EC的标准治疗方法是子宫切除加输卵管卵巢切除术。然而，对于那些希望保留生育能力的患者，口服孕激素如醋酸甲羟孕酮（MPA）或醋酸甲地孕酮（MA）是保留生育功能治疗（FST）中最常用的疗法。其他治疗方法包括促性腺激素释放激素激动剂（GnRHa）、左炔诺孕酮宫内节育系统（LNG-IUS）以及二甲双胍加孕激素。这篇综述评估了具有生育潜力的女性的最佳FST方案。2023年6月，使用特定关键词在PubMed、EMBASE和Scopus数据库进行了检索。纳入综述的研究聚焦于接受FST的EC患者，其结果包括完全缓解率（CRR）、复发率（RR）、妊娠率（PR）和活产率。18项研究符合纳入标准，涉及23976名患者。在仅使用口服孕激素的试验中，CRR范围为18%至100%；RR范围为0%至81.8%；死亡率范围为0%至3.6%。在口服孕激素与LNG-IUS联合使用的研究中，CRR范围为55%至87.5%；RR范围为0%至41.7%；死亡率为0%。大多数IA期EC患者接受MPA或MA治疗。15项研究报告了与生育相关的结果。在仅涉及口服孕激素的试验中，PR范围为4至44例患者。当口服孕激素与LNG-IUS联合使用时，PR范围为1至46例患者。孕激素治疗，包括口服MPA和MA，被认为是安全有效的，支持使用LNG-IUS的证据有限。
