Meta-analysis Of Fertility-preserving Treatment In Young Patients With Endometrial Atypical Hyperplasia

Objective: To study the treatment of fertility preservation in young patients with endometrial atypical hyperplasia,like progesterone treatment,levonorgestrel-releasing intrauterine system combined with progesterone or GnRH-a,hysteroscopy conservative surgery followed by progestin.To evaluate the clinical efficacy of fertility-preserving treatment from complete remission rate,recurrence rate,pregnancy rate,birth rate and progression rate.Methods: We use computer retrieval tools search the keywords "endometrial atypical hyperplasia","fertility-preserving" and their synonyms from Pubmed database,Cochrane Library,Wanfang medical database,CNKI and so on.Collect all relevant literature about fertility-preserving treatment in young patients with endometrial atypical hyperplasia from January 2000 to March 2019.Languages were restricted to Chinese and English.Studies were selected,according to strict inclusion and exclusion criteria.All the calculations and statistical tests were done with the R software(R 3.5.2).Results: 18 articles including 415 patients were enrolled in this study.The results showed: The complete remission rate of simple use of progesterone in the treatment of endometrial atypical hyperplasia is 83.47%,95%CI [0.7501;0.8946],the recurrence rate is 20.89%,95%CI [0.1588;0.2698],the pregnancy rate is 29.08%,95%CI [0.2359;0.3526].The complete remission rate of using hysteroscopy conservative surgery followed by progestin is 83.92%,95%CI [0.7004;0.9209],the recurrence rate is 6.69%,95%CI [0.0378;0.1157],the pregnancy rate is 45.52%,95%CI [0.3841;0.5283].The complete remission rate of using levonorgestrel-releasing intrauterine system combined with progesterone or GnRH-a is 88.68%,95%CI [0.7923;0.9415],the recurrence rate is 10.73%,95%CI [0.0498;0.2160].The total birth rate of fertility-preserving treatment in young patients with endometrial atypical hyperplasia is 24.87%,95%CI [0.1852;0.3253],the total progression rate is 4.08%,95%CI [0.0263;0.0627].Conclusion: The available evidence suggests that treatment with oral progestin or LNG-IUS therapy combined with progesterone or hysteroscopic surgery are all effective in the treatment of endometrial atypical hyperplasia for fertility-preserving.Most patients can manage to get pregnancy and delivery.But the possibility of recurrence and progression after complete remission is exist,so long-term follow-up is necessary.