Prognostics factors of oncologic and reproductive outcomes in fertility sparing management of endometrial atypical hyperplasia and adenocarcinoma Systematic review and meta analysis

In this meta-analysis including patients who underwent uterine preservation for endometrial neoplasia, oncologic and reproductive outcomes were not impaired in older patients with previous infertility or obesity.

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Authors

Martin Koskas, M.D., Jennifer Uzan, M.D., Dominique Luton, M.D., Ph.D., Roman Rouzier, M.D., Ph.D., Emile Daraï, M.D., Ph.D.

Volume 101, Issue 3, Pages 785-794.e3, March 2014

Abstract

Objective:

To evaluate the various possible prognostic factors on the fertility-sparing management of atypical hyperplasia and endometrial cancer; to generate survival curves to estimate remission and recurrence rates according to time.

Design:

Systematic review and meta-analysis. Registration number: CRD42013004557.

Setting:

University hospital.

Patient(s):

Patients who underwent fertility-sparing management for atypical hyperplasia and endometrial cancer.

Intervention(s):

All published studies were identified through MEDLINE and reported according to PRISMA guidelines.

Main Outcome Measure(s):

Remission, recurrence, progression, and pregnancy rates by age, obesity, infertility, previous pregnancy, histology, and medical treatment.

Result(s):

A total of 370 patients from 24 studies were included. The 12- and 24-month remission probabilities were 78.0% and 81.4%, respectively. In multivariate analysis, previous pregnancy (odds ratio [OR] 2.70, 95% confidence interval [CI] 1.23–5.89), infertility (OR 2.26, 95% CI 1.05–4.87), and treatment with megestrol acetate (OR 2.70, 95% CI 1.20–6.02) were associated with higher remission probability. The 12- and 24-month recurrence probabilities were 9.6% and 29.2%, respectively. In multivariate analysis, none of the factors studied was associated with higher recurrence probability. Twenty-two studies totaling 351 patients were used to assess pregnancy rate; 111 subjects (32%) had one pregnancy or more. In multivariate analysis, none of the factors were associated with pregnancy probability. Among the 263 patients used to assess progression rate, 39 (15%) had a tumor with at least myometrial invasion on the hysterectomy specimen. Endometrial cancer and the use of other medical therapies (in comparison with megestrol acetate) were associated with an increased probability of progression.

Conclusion(s):

Fertility-sparing management should not be contraindicated in older patients with previous infertility or obesity.

Read the full text at: http://www.fertstert.org/article/S0015-0282(13)03288-3/fulltext


Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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