He Ling, Wei Jiayu, Kuai Dan, Zhang Dongcan, Zhang Yanfang, Tian Wenyan, Zhang Huiying, Wang Yingmei
Department of Obstetrics and Gynecology, Tianjin Key Laboratory of Female Reproductive Health and Eugenics, Tianjin, China.
Tianjin Medical University General Hospital, Tianjin, China.
Reprod Sci. 2025 May 19. doi: 10.1007/s43032-025-01874-y.
Despite broad consensus on the oncological criteria for the inclusion of patients in conservative therapy for endometrial cancer (EC), several prognostic factors affecting patients' subsequent oncological and reproductive outcomes have yet to be explored. To assess the prognostic factors influencing remission, pregnancy and recurrence in conservative therapy of endometrial hyperplasia (EH) and EC. Following the PRISMA statement and the Cochrane Handbook, the search for relevant studies was conducted in PubMed, Embase, Web of Science, Wan fang and China National Knowledge Infrastructure from the inception of the databases to 1 March 2024. Studies that met the inclusion criteria were evaluated for quality using the Newcastle-Ottawa Scale and subsequently analyzed for data extraction. This meta-analysis included 3815 patients with EC or EH treated with conservative therapy in 35 studies. The analysis revealed the overall remission rate of 92.0% (95% CI, 87.0-96.0%), pregnancy rate of 34.0% (95% CI, 32.0-36.0%), and recurrence rate of 27.0% (95% CI, 25.0-29.0%). Four study characteristics, including obesity, pathology type, lesion size, and insulin resistance were associated with remission rate. A total of 8 study characteristics were found to be associated with pregnancy rate, including obesity, pathology type, time to complete response (CR), mode of conception, intrauterine adhesion, the number of uterine manipulations, endometrial thickness and recurrence before pregnancy. Seven study characteristics were found to be associated with recurrence rate, including age over 35.0 years, obesity, family history of cancer, pathological type, abnormal menstruation, pregnancy and maintenance treatment after CR. Common prognostic factors affecting remission, pregnancy and recurrence of endometrial cancer and endometrial hyperplasia are obesity and type of pathology. Patient characteristics, medical factors, and pathological features significantly influence oncological and reproductive outcomes in patients with EH and EC undergoing conservative therapy. Consequently, careful clinical selection and individualized assessment of each candidate for conservative therapy are essential to optimally balance short-term oncological and reproductive outcomes with long-term survival prognosis.
尽管在子宫内膜癌（EC）保守治疗患者纳入的肿瘤学标准方面已达成广泛共识，但影响患者后续肿瘤学和生殖结局的几个预后因素仍有待探索。为评估影响子宫内膜增生（EH）和EC保守治疗中缓解、妊娠和复发的预后因素。按照PRISMA声明和Cochrane手册，从数据库建立至2024年3月1日，在PubMed、Embase、Web of Science、万方和中国知网中检索相关研究。使用纽卡斯尔-渥太华量表对符合纳入标准的研究进行质量评估，随后进行数据提取分析。该荟萃分析纳入了35项研究中接受保守治疗的3815例EC或EH患者。分析显示总体缓解率为92.0%（95%CI，87.0 - 96.0%），妊娠率为34.0%（95%CI，32.0 - 36.0%），复发率为27.0%（95%CI，25.0 - 29.0%）。包括肥胖、病理类型、病变大小和胰岛素抵抗在内的四个研究特征与缓解率相关。共发现8个研究特征与妊娠率相关，包括肥胖、病理类型、完全缓解（CR）时间、受孕方式、宫腔粘连、子宫操作次数、子宫内膜厚度和妊娠前复发。发现7个研究特征与复发率相关，包括年龄超过35.0岁、肥胖、癌症家族史、病理类型、月经异常、妊娠和CR后的维持治疗。影响子宫内膜癌和子宫内膜增生缓解、妊娠和复发的常见预后因素是肥胖和病理类型。患者特征、医学因素和病理特征显著影响接受保守治疗的EH和EC患者的肿瘤学和生殖结局。因此，对每位保守治疗候选者进行仔细的临床筛选和个体化评估，对于最佳平衡短期肿瘤学和生殖结局与长期生存预后至关重要。
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