Diabetes mellitus and responsiveness of endometrial hyperplasia and early endometrial cancer to conservative treatment

Abstract

Objective: The conservative treatment of endometrial hyperplasia without atypia (HWA), atypical endometrial hyperplasia (AH/EIN) and early endometrioid carcinoma (EEC) is based on progestins. We aimed to assess whether diabetes mellitus affects the responsiveness of HWA, AH/EIN and EEC to conservative treatment, through a systematic review and meta-analysis.

Study design: Electronic databases were searched for studies assessing the outcome of conservative treatment in HWA, AH/EIN and EEC, stratified based on the diagnosis of diabetes mellitus. The association of diabetes mellitus with treatment failure was assessed by using odds ratio (OR). A p-value  < .05 was considered significant. The risk of publication bias was assessed by using a funnel plot. A subgroups analyses was performed based on histologic diagnosis of benignity (HWA) or premalignancy/malignancy (AH/EIN or EEC).

Results: Six studies with 876 patients (383 HWA, 365 AH/EIN and 128 EEC) were included. Overall, diabetes mellitus was not associated with outcome of treatment (OR = 1.20; p = .62). The association was not significant in both the HWA subgroup (OR = 0.95; p = .93) and in AH/EIN and EEC subgroup (OR = 1.43; p = .46). There was no significant risk of publication bias.

Conclusions: Diabetes mellitus does not affect the outcome of conservative treatment in HWA, AH/EIN and EEC.

摘要

目的：以孕激素为基础保守治疗无异型性子宫内膜增生（HWA）、不典型子宫内膜增生（AH/EIN）和早期子宫内膜样癌（EEC）。我们旨在通过系统回顾和荟萃分析, 评估糖尿病是否影响HWA、AH/EIN和EEC对保守治疗的反应性。

研究设计：检索电子数据库, 以评估在HWA、AH/EIN和EEC中保守治疗的结果, 并根据糖尿病的诊断分层。用比值比（OR）评价糖尿病与治疗失败的相关性。p值＜0.05被认为是显著的。使用漏斗图评估发表偏倚的风险。根据良性（HWA）或癌前病变/恶性肿瘤（AH/EIN或EEC）的组织学诊断进行亚组分析。

结果：共纳入6项研究876例（383 HWA, 365 AH/EIN, 128 EEC）。总的来说, 糖尿病与治疗结果无关（OR＝1.20, P＝0.62）。HWA亚组（OR＝0.95, P＝0.93）和AH/EIN和EEC亚组（OR＝1.43, P＝0.46）的相关性不显著。发表偏倚没有显著的风险。

结论：糖尿病不影响HWA、AH/EIN和EEC的保守治疗结果。

The Chinese abstracts are translated by Prof. Dr. Xiangyan Ruan and her team: Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.

Keywords:

• Endometrial hyperplasia
• endometrial intraepithelial neoplasia
• diabetes
• endometrioid carcinoma
• fertility-sparing

Disclosure statement

No potential conflict of interest was reported by the authors.