Surgery/Progesterone Improves Responses, Pregnancy in Endometrial Cancers

"We ascertained that hysteroscopic surgery combined with progesterone therapy was superior to the overall efficacy of conservative management without distinguishing treatment types," according to the study authors.

Combining hysteroscopic surgery with progesterone therapy produced improvements in overall response rate (ORR), disease recurrence rate, and pregnancy rates among those with early endometrial cancer and atypical endometrial hyperplasia (AEH) or endometrial intraepithelial neoplasia (EIN), according to results from a meta-analysis published in Archives of Gynecology and Obstetrics.

Among 170 patients with endometrial cancer that were described in 12 pieces of literature, investigators reported a pregnancy rate of 49% (95% CI, 33%-65%). The corresponding rate for 149 patients with AEH or EIN who were described in 6 articles was 47% (95% CI, 31%-64%).

The live birth rate among 164 patients with endometrial cancer as reported in 11 pieces of literature was 45% (95% CI, 32%-58%). Additionally, the live birth rate was 44% (95% CI, 34%-54%) for 112 patients with AEH or EIN who had available data in 5 articles.

Of 239 patients with endometrial cancer, 90% (95% CI, 85%-94%) experienced a complete response (CR) based on reports from 13 pieces of literature. Additionally, investigators reported that the CR rate in 199 patients with AEH or EIN was 100% (95% CI, 97%-100%) across 6 pieces of literature.

The disease recurrence rate was 17% (95% CI, 8%-28%) among 239 patients with endometrial cancer across 13 pieces of literature. Additionally, data from 6 articles highlighted a corresponding rate of 11% (95% CI, 3%-23%) for 199 patients with AEH or EIN.

“We ascertained that hysteroscopic surgery combined with progesterone therapy was superior to the overall efficacy of conservative management without distinguishing treatment types,” the study authors wrote. “Hysteroscopic surgery combined with progesterone therapy is feasible for the treatment of patients with [endometrial cancer] and AEH/EIN of childbearing age, which is associated with higher [ORRs], lower disease recurrence rates, and better pregnancy/live birth rates in patients.”

Investigators used databases including Embase and PubMed to collect data on combination treatment with hysteroscopic surgery and progesterone therapy in patients with early endometrial cancer and AEH or EIN. Retrieving literature involved searches using keywords such as “early-stage EC,” “AEH,” “EIN,” “fertility preservation,” and “conservative treatment.”

When screening literature, investigators included data on patients with stage IA, highly differentiated endometrial cancer, AEH, and EIN who wanted to preserve their fertility. Articles that were also eligible for inclusion in the meta-analysis were those that examined hysteroscopic surgery plus progesterone as the primary treatment method and assessed pregnancy rate and/or live birth rate, CR rate, or recurrence rate as outcome variables following conservative treatment. Investigators did not include repeated publications, guidelines, reviews, or case reports as part of their analysis.

Investigators initially retrieved a total of 1023 articles before excluding 57 duplicate pieces. Thirteen articles met all eligibility criteria for the meta-analysis after investigators excluded irrelevant literature.

In total, 53.8% of studies were conducted in Asia, and 46.2% were conducted in Europe. All pieces of literature were either case studies (69.2%) or cohort studies (30.8%). Most patients in these studies received 160 mg per day of megestrol acetate. The studies had median follow-up times that ranged from 24 to 194 months.

According to the investigators, there may have been potential bias in the studies collected for the literature review, as most had small sample sizes and were conducted retrospectively. Other limitations to the meta-analysis included the large heterogeneity of the studies and the fact that investigators lacked data on patient body mass index and comorbidities.

Reference

Ye X, Li T. Effects of hysteroscopic surgery combined with progesterone therapy on fertility and prognosis in patients with early endometrial cancer and atypical endometrial hyperplasia or endometrial intraepithelial neoplasia: a meta-analysis. Arch Gynecol Obstet. Published online August 4, 2023. doi:10.1007/s00404-023-07173-8