The Meta-analysis Of Fertility Preserving In Patitents With Early Stage Endometrial Cancer

Objective: Endometrial cancer is the second most common genital malignancy worldwide.The incidence rate is gradually increasing and younger.The standard treatment for patients with early stage endometrial cancer is total hysterectomy and bilateral salpingo-oophorectomy with or without lymphadenectomy,which makes the patients permanently lose fertility.For young patients who are eager to retain fertility,conservative treatment is of great importance.At present,most of the treatment programs for fertility preservation are small sample clinical studies,lacking evidence-based medicine.In this paper,we use the method of meta analysis to treat young patients with early stage endometrial cancer with fertility preservation,such as oral progestin treatment,hysteroscopic resection of lesion combined with other treatment methods(other methods: progestin,LNG-IUS,Gn RH-a),levonorgestrel-releasing intrauterine system or combined with other treatment methods(other methods: progestin,Gn RH-a).The safety and effectiveness of the three conservative treatments were evaluated in terms of complete response rate,recurrence rate,pregnancy rate and live birth rate.Method: Searching database by computer: Pubmed,Embase,the Cochrane Library,web of Science,CNKI,Wanfang database,VIP datebase,CBM,collected the study of fertility preserving therapy for patients under 40 years old with early well differentiated endometrial cancer from January 1999 to October 2019,through reading the full text,according to the inclusion and exclusion criteria,the study was screened,the data was extracted,the quality was evaluated,and the inclusion was performed using R software(version R3.5.3)meta analysis of single sample rate.Result: In this study,there were 51 articles,1246 patients with early stage endometrial cancer.Among them,646 cases were treated by oral progestin,509 cases by hysteroscopic resection of lesion combined with other treatment methods,91 cases by levonorgestrel-releasing intrauterine system or combined with other treatment methods.Using R3.5.3 statistical software to make a meta analysis of the single sample rate of each treatment method.The statistical results show that in the conservative treatment of early stage endometrial cancer patients,the complete response rate of oral progestin treatment is 75%,95% confidence interval [0.69;0.81],recurrence rate is 34%,95% confidence interval [0.29;0.39],pregnancy rate is 70%,95% confidence interval [0.64],live birth rate was 64%,95% confidence interval [0.57;0.71].The complete response rate of hysteroscopic resection of lesion combined with other treatments was 91%,95% confidence interval [0.86;0.95],recurrence rate was 11%,95% confidence interval [0.07;0.18],pregnancy rate was 87%,95% confidence interval [0.84;0.91],live birth rate was 71%,95% confidence interval [0.63].The complete response rate of levonorgestrelreleasing intrauterine system or combined with other treatment methods(other methods: progestin,Gn RH-a)was 69%,95% confidence interval [0.54;0.89],recurrence rate was 30%,95% confidence interval [0.19;0.49],pregnancy rate was 48%,95% CI [0.18;1.0],live birth rate was 36%,95% confidence interval [0.1;1.0].Conclusion:1.It is safe and effective for young patients with early stage endometrial cancer to oral progestin treatment,to use hysteroscopic resection of lesion combined with other treatment methods,to use levonorgestrel-releasing intrauterine system or combined with other treatment methods.2.Any conservative treatment has the possibility of recurrence in the near and long term,so it needs long-term follow-up.At present,most of the literatures on conservative treatment of early stage endometrial cancer are small sample clinical research and retrospective case analysis.In the future,large sample randomized controlled study is needed to compare the curative effect of different conservative treatment methods and choose a more appropriate method.