J Gynecol Oncol.
2023 Jul;34(4):e49. 10.3802/jgo.2023.34.e49.
Effects of a fertility-sparing re-treatment for recurrent atypical endometrial hyperplasia and endometrial cancer: a systematic literature review
- Affiliations
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- 1Department of Obstetrics and Gynecology, Toho University Ohashi Medical Center, Tokyo, Japan
- 2Department of Obstetrics and Gynecology, Tokai University School of Medicine, Isehara, Japan
- 3Department of Obstetrics and Gynecology, Kyorin University Faculty of Medicine, Tokyo, Japan
- 4Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Tokyo, Japan
- 5Department of Obstetrics and Gynecology, Tokyo Women’s Medical University, Tokyo, Japan
- 6Division of Gynecology, Shizuoka Cancer Center, Shizuoka, Japan
- 7Department of Obstetrics and Gynecology, Iwate Medical University, Iwate, Japan
- 8Department of Obstetrics and Gynecology, Yamagata University Faculty of Medicine, Yamagata, Japan
- KMID: 2552632
- DOI: http://doi.org/10.3802/jgo.2023.34.e49
Abstract
Objective
To examine the effectiveness of progestin re-treatment for recurrent endometrial intraepithelial neoplasia (EIN), atypical endometrial hyperplasia (AH) and endometrial cancer (EC) following initial fertility-sparing treatment.
Methods
A comprehensive systematic review and meta-analysis were conducted by an Expert Panel of the Japan Society of Gynecologic Oncology Endometrial Cancer Committee. Multiple search engines, including PubMed/MEDLINE and the Cochrane Database, were searched in December 2021 using the keywords “Endometrial neoplasms,” “Endometrial hyperplasia,” “Endometrial intraepithelial neoplasia,” “Fertility preservation,” “Progestins,” AND “Recurrence.” Cases describing progestin re-treatment for recurrent EIN, AH and EC were compared with cases that underwent conventional hysterectomy. The primary outcomes were survival and disease recurrence, and the secondary outcome was pregnancy.
Results
After screening 238 studies, 32 with results for recurrent treatment were identified. These studies included 365 patients (270 received progestin re-treatment and 95 underwent hysterectomy). Most progestin re-treatment involved medroxyprogesterone acetate or megestrol acetate (94.5%). Complete remission (CR) following progestin re-treatment was achieved in 219 (81.1%) cases, with 3-, 6- and 9-month cumulative CR rates of 22.8%, 51.7% and 82.6%, respectively. Progestin re-treatment was associated with higher risk of disease recurrence than conventional hysterectomy was (odds ratio [OR]=6.78; 95% confidence interval [CI]=1.99–23.10), and one patient (0.4%) died of disease. Fifty-one (14.0%) women became pregnant after recurrence, and progestin re-treatment demonstrated a possibility of pregnancy (OR=2.48; 95% CI=0.94–6.58).
Conclusion
This meta-analysis suggests that repeat progestin therapy is an effective option for women with recurrent EIN, AH and EC, who wish to retain their fertility.
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