Comparison among fertility-sparing therapies for well differentiated early-stage endometrial carcinoma and complex atypical hyperplasia.
Comparison among fertility-sparing therapies for well differentiated early-stage endometrial carcinoma and complex atypical hyperplasia.
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高分化早期子宫内膜癌与复杂不典型增生保留生育功能的比较
DOI：
10.18632/oncotarget.17588
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发表时间：
2017-08-22
期刊：
影响因子：
--
通讯作者：
Kong B
中科院分区：
文献类型：
--
作者：
Zhang Q;Qi G;Kanis MJ;Dong R;Cui B;Yang X;Kong B
目的比较口服孕激素、宫腔镜电切术（HR）、左炔诺孕酮宫内缓释系统（LNG-IUS）等保留生育能力的治疗方法对早期高分化子宫内膜癌（eEC）和复杂性子宫内膜不典型增生（CAH）患者的疾病消退、复发和活产率的影响。研究设计：这是一项荟萃分析，以前的研究集中在生育保留治疗分化良好的早期子宫内膜癌（eEC）和复杂的非典型增生（CAH）。使用术语和同义词检索Medline、科克伦图书馆和Embase：与eEC和CAH相关的保留生育力治疗相似的词。主要观察指标：抽取各研究中接受生育保留治疗的患者数、消退、复发和分娩的患者数，计算各研究的消退、复发和活产率。借助R语言编写的“Meta”和“Meta for”软件包中的元回归，比较两种干预措施之间的回归、复发和活产率。结果纳入了54项研究报告了eEC和CAH年轻女性的生育保留治疗。Meta分析结果显示，HR联合孕激素治疗组的合并回归率（98.06% vs77.20%，P < 0.0001）和活产率（52.57% vs33.38%，P = 0.0944）均高于单用孕激素治疗组（4.79% vs32.17%，P = 0.0004），且复发率较低。与此同时，HR联合孕激素组的合并活产率（52.57% vs 18.09%，P =0.0399）显著高于单独LNG-IUS组。复发率（4.79%vs3.90%，P = 0.8561）和消退率（98.06%vs94.24%，P = 0.4098）无统计学差异。结论在现有的保留生育能力的治疗方案中，HR后孕激素可能是一种更有效的治疗方案。
Objective To compare fertility-sparing therapies including oral progestogens, hysteroscopic resection (HR), and the levonorgestrel- releasing intrauterine system (LNG-IUS) in achieving disease regression, recurrence and live birth rate in well differentiate early-stage endometrial carcinoma (eEC) and complex atypical hyperplasia(CAH). Study Design This was a meta-analysis of previous studies focus on the fertility-sparing therapy for well differentiate early-stage endometrial carcinoma (eEC) and complex atypical hyperplasia (CAH). Date Sources Medline, the Cochrane Library and Embase was searched with the terms and Synonyms: words similar to eEC and CAH with therapies associated with fertility-sparing. Main Outcome Measures The number of all patients accepted fertility sparing therapies, patients got regressed, relapsed and delivered were extracted from each study, and the regression, recurrence, and live birth rate of each study were calculated. The regression, recurrence and live birth rates between each two interventions were compared with the aid of meta-regression in packages of “meta” and ”meta for” written in R. Results Fifty-four studies reported fertility sparing therapies in young women with eEC and CAH were included. Meta-analysis showed that HR followed by progestogens achieved a higher pooled regression (98.06% vs 77.20% P < 0.0001) and live birth rate (52.57% vs 33.38%, P = 0.0944) and a lower recurrence rate compared with oral progestogens alone (4.79% vs 32.17% P = 0.0004). At the same time, the pooled live birth rate (52.57% vs 18.09% P =0.0399) of HR followed by progestogens are significantly higher than the LNG-IUS alone. Which no statistical difference in regression (98.06% vs 94.24%; P = 0.4098) and recurrence rates (4.79% vs 3.90% P = 0.8561) was seen. Conclusions Of the available fertility-sparing therapeutic options, HR followed by progestogens may be a more effective one.
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