The oncological and reproductive outcomes of fertility-preserving treatments for stage 1 grade 1 endometrial carcinoma: a systematic review and meta-analysis

Abstract

Introduction

The number of patients desiring fertility-preserving treatment for endometrial cancer rather than standard surgical management continues to increase.

Objective

We aimed to evaluate the efficacies of fertility-preserving treatments on the live birth rate, remission and relapse rates for women with stage 1a grade 1 endometrial carcinoma to support patient counselling.

Methods

We performed a meta-analysis for our primary outcomes of overall remission and relapse rate, and for secondary analysis, we divided papers into treatment type: systemic progestins, intrauterine progestins or hysteroscopic resection and adjuvant hormonal treatment.

Results

Thirty-five observational studies met inclusion criteria, with a total of 624 patients. Overall, conservative treatment of endometrial cancer showed a remission rate of 77% (95% CI: 70–84%), a relapse rate of 20% (95% CI: 13–27%) and a live birth rate of 20% (95% CI: 15–25%) with more favourable outcomes for the hysteroscopic resection group.

Conclusions

Hysteroscopic resection and adjuvant hormonal treatment had the most favourable fertility and oncological outcomes. Further high-quality prospective multi-centre trials are warranted to determine the optimal treatment regimen and dosage and risk stratification for these patients.

Plain Language Summary

The number of women diagnosed with womb cancer who want to preserve their fertility is increasing. Traditional treatment involves surgery to remove the womb and ovaries, rendering women infertile. Fertility-preserving treatments (e.g. hormone therapy, removing only affected areas) exist but their impact on remission, relapse and fertility is not certain. Our team discovered that for women who underwent fertility-preserving treatment: three in four had cancer remission, one in five had cancer relapse and one in five had a successful birth. More research is needed to work out the best fertility-preserving treatment and identify which women are more likely to have successful pregnancies.

Overall, our research will help to counsel women diagnosed with womb cancer who want to preserve their fertility or are unsuitable for major surgery more effectively.

Keywords:

• Endometrial cancer
• fertility preserving
• progesterone
• hysteroscopic resection

Acknowledgements

The authors would like to thank Jacqueline Smith, librarian at University College London library services, for her assistance with the literature search.

Author contributions

MO: study selection, data extraction, risk of bias assessment, statistical analysis, manuscript drafting and revision.

SO: study selection, data extraction, risk of bias assessment, manuscript drafting and revision.

RG: study selection and manuscript revision.

AO: conceptualisation, supervision and manuscript revision.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding author, MO, upon reasonable request.

Additional information

Funding

The authors declare no funding.