Clinical And Reproductive Outcomes Of Endometrial Atypical Hyperplasia And Early Endometrial Cancer After Fertility Preservation:A Meta-analysis

Objective:Our research objectively is to evaluate the clinical outcomes and reproductive outcomes of patients who have EAH and EEC after different fertility preservation treatments by systematic reviews,and provide evidence-based support for guiding clinical treatment.Methods:By searching articles from Pub Med,The Cochrane Library,Web of Science,EMbase,China Knowledge Network(CNKI),China Biomedical Literature Database(CBM),VIP Chinese Journal Full-text Database(VIP),Wanfang and other databases,we studied the publicly published literature in Chinese and in English on the clinical outcomes and reproductive outcomes of patients with EAH and EEC after different treatments.Manually searched relevant literature to identify other eligible trials.The articles published from January,2000 to December,2020.In strict accordance with the established inclusion and exclusion criteria,two researchers filtrated the retrieved articles,appraised their quality,and drawed information all alone.Statistical analysis was performed using Stata 12.0 software.Results:A total of 31 articles were included in this study,including 10 articles in Chinese and 21 articles in English,with a total of 1799 cases,of which 18 articles were treated with high-efficiency progesterone and 1090 patients were enrolled,intrauterine placement of LNG-IUS or combined with other drug treatments 3 articles,a total of120 patients were enrolled,another 10 articles on hysteroscopic endometrial lesion resection combined with other drug,and a total of 589 patients were enrolled.Meta-analysis consequence displayed that the complete remission ratio of oral high-potency progesterone remedy of EAH and EEC was 82%,95% CI:[0.78-0.87];the recurrence ratio was 26%,95% CI:[0.20-0.33];the pregnancy ratio was 44%,95%CI:[0.37-0.52];the live ratio was 29%,and the 95% CI:[0.23-0.36].The complete remission ratio of LNG-IUS or combined with other drug treatment with intrauterine putting of EAH and EEC was 83%,95% CI:[0.76-0.90];the recurrence ratio was 12%,95% CI:[0.01-0.23];the pregnancy ratio was 20%,and 95% CI:[0.12-0.28];the live ratio was 18%,and 95% CI:[0.10-0.26].The complete remission ratio of hysteroscopic endometrial lesion resection combined with other drug treatment of EAH and EEC was 90%,and 95% CI:[0.88-0.93];the recurrence ratio was 8%,95%CI:[0.06-0.10];the pregnancy ratio was 50%,95% CI:[0.38-0.62];the live ratio is37%,95% CI:[0.25-0.49].Oral high-efficiency progesterone was compared with intrauterine placement of LNG-IUS or combined with other drug treatments,the complete remission ratio was lower,and the difference was not statistically significant(P=0.9248);the recurrence ratio was higher,and the difference was statistically significant(P=0.0283);the pregnancy ratio was higher,and the difference was statistically significant(P=0.0130),the live ratio was higher,the difference was statistically significant(P=0.0298).Oral high-efficiency progesterone therapy was compared with hysteroscopic endometrial lesion resection combined with other drug treatments,the complete remission ratio was lower,and the difference was statistically significant(P=0.0066);the recurrence ratio was higher,and the difference was statistically significant(P<0.0001);the pregnancy ratio was lower,and the difference was not statistically significant(P=0.9489);the live ratio was lower,the difference was not statistically significant(P=0.6349).Intrauterine placement of LNG-IUS or combined with other drug therapy was compared with hysteroscopic endometrial lesion resection combined with other drug therapy,the complete remission ratio was lower,and the difference was statistically significant(P=0.0408);the recurrence ratio was higher,and the difference was not statistically significant(P=0.5915);the pregnancy ratio was lower,and the difference was statistically significant(P=0.0391);the live ratio was lower,the difference was not statistically significant(P=0.0546).Conclusions:1.Oral high-efficiency progesterone,intrauterine placement of LNG-IUS or combined with other drug therapy,hysteroscopic endometrial lesion resection combined with other drug treatments for the patients of EAH and EEC are all safe and effective fertility preservation therapy.2.Hysteroscopic lesion resection before drug treatment has the highest complete remission rate compared with oral high-efficiency progesterone and intrauterine LNG-IUS or combined with other drug.Oral high-efficiency progesterone therapy has a higher recurrence rate compared with intrauterine placement of LNG-IUS or combined with other drug therapy and hysteroscopic endometrial lesion resection combined with other drug treatments.Oral high-efficiency progesterone and hysteroscopic endometrial lesion resection combined with other drug treatments have better pregnancy outcomes than intrauterine LNG-IUS or combined with other drug.3.For childbearing age women suffering from EAH and EEC,after strict population selection,conservative treatment strategies can be regarded as effective treatment options,but the disease has a risk of recurrence,and clinical treatment needs to pay close attention to the clinical efficacy and adverse effects response and strict close follow-up should be carried out.