A systematic review and meta-analysis of prognostic factors for remission in fertility-sparing management of endometrial atypical hyperplasia and adenocarcinoma.
Adenocarcinoma
/ pathology
Adult
Endometrial Hyperplasia
/ surgery
Endometrial Neoplasms
/ surgery
Female
Fertility Preservation
/ methods
Humans
Hysteroscopy
/ methods
Infertility, Female
/ prevention & control
Precancerous Conditions
/ surgery
Pregnancy
Prognosis
Prospective Studies
Remission Induction
/ methods
Retrospective Studies
Adenocarcinoma
Atypical hyperplasia
Endometrial cancer
Fertility sparing
Meta-analysis
Operative hysteroscopy
Remission
Systematic review
Journal
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics
ISSN: 1879-3479
Titre abrégé: Int J Gynaecol Obstet
Pays: United States
ID NLM: 0210174
Informations de publication
Date de publication:
Sep 2019
Sep 2019
Historique:
received:
28
12
2018
revised:
19
04
2019
accepted:
12
06
2019
pubmed:
15
6
2019
medline:
16
10
2019
entrez:
15
6
2019
Statut:
ppublish
Résumé
Endometrial cancer and atypical hyperplasia are rare in young women but create a dilemma between desire for pregnancy and oncologic outcomes. To identify remission rates and associated prognostic factors in patients undergoing fertility-sparing management for endometrial cancer and atypical hyperplasia. MEDLINE was searched for studies published between January 1, 1950 and July 31, 2017 using various search terms. Studies evaluating fertility-sparing management in patients aged between 19 and 44 years with atypical hyperplasia or stage I endometrial cancer. Use of PRISMA guidelines to conduct a meta-analysis of the proportion of patients in remission and meta-regression analysis to test the effect of possible prognostic factors for remission. A total of 3673 studies were screened; 65 studies including 1604 patients met the inclusion criteria. The remission rate was 0.75 (95% CI, 0.73-0.77). Operative hysteroscopy for endometrial sampling was associated with higher remission rates (OR 2.31; 95% CI, 1.10-4.84; P=0.03). Studies with higher ratios of infertile women were associated with higher remission rates (OR 4.21; 95% CI, 1.44-12.33; P<0.01). Operative hysteroscopy is the preferred endometrial sampling method for patients with atypical hyperplasia or endometrial cancer undergoing fertility-sparing management.
Sections du résumé
BACKGROUND
BACKGROUND
Endometrial cancer and atypical hyperplasia are rare in young women but create a dilemma between desire for pregnancy and oncologic outcomes.
OBJECTIVE
OBJECTIVE
To identify remission rates and associated prognostic factors in patients undergoing fertility-sparing management for endometrial cancer and atypical hyperplasia.
SEARCH STRATEGY
METHODS
MEDLINE was searched for studies published between January 1, 1950 and July 31, 2017 using various search terms.
SELECTION CRITERIA
METHODS
Studies evaluating fertility-sparing management in patients aged between 19 and 44 years with atypical hyperplasia or stage I endometrial cancer.
DATA COLLECTION AND ANALYSIS
METHODS
Use of PRISMA guidelines to conduct a meta-analysis of the proportion of patients in remission and meta-regression analysis to test the effect of possible prognostic factors for remission.
MAIN RESULTS
RESULTS
A total of 3673 studies were screened; 65 studies including 1604 patients met the inclusion criteria. The remission rate was 0.75 (95% CI, 0.73-0.77). Operative hysteroscopy for endometrial sampling was associated with higher remission rates (OR 2.31; 95% CI, 1.10-4.84; P=0.03). Studies with higher ratios of infertile women were associated with higher remission rates (OR 4.21; 95% CI, 1.44-12.33; P<0.01).
CONCLUSION
CONCLUSIONS
Operative hysteroscopy is the preferred endometrial sampling method for patients with atypical hyperplasia or endometrial cancer undergoing fertility-sparing management.
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
277-288Informations de copyright
© 2019 International Federation of Gynecology and Obstetrics.