Objectives: This study aimed to identify potential prognostic factors for patients with complex atypical hyperplasia (CAH) or early-stage endometrial cancer (EC) who received progestin therapy to spare fertility and, thus, improve the management of this patient group.
Materials and methods: The PubMed, PMC, EMBASE, Web of Science, and Cochrane databases were searched for correlational studies published in English. Studies that evaluated the prognosis of patients with CAH or early-stage EC were pooled for a systematic review and meta-analysis.
Results: In total, 31 eligible studies, including 8 prospective and 23 retrospective studies involving 1099 patients, were included in this analysis. The most commonly used progestin agents were medroxyprogesterone acetate (MPA, 47.0%) and megestrol acetate (MA, 25.5%). The total complete response (CR) rate was 75.8% (833/1099), and the median time to CR with first-line progestin therapy was 6 months. In total, 294 (26.8%) patients who achieved CR became pregnant spontaneously (28 cases) or through assisted reproductive technology (127 cases). During the median follow-up of 39 months, 245 (22.3%) women developed recurrence. Only one patient (0.09%) died of the disease. The meta-analysis showed that compared to a BMI<25 kg/m², and CAH, a body mass index (BMI) ≥25 kg/m² (P =0.0004, odds ratios (OR), 0.4; 95% confidence interval, 0.3–0.6) and EC (P =0.0000, OR, 0.3; 95% confidence interval, 0.2–0.6) were significantly associated with a higher likelihood of a CR. Patients with a BMI≥25 kg/m² (P =0.0007, OR, 2.5; 95% confidence interval, 1.4–4.3), PCOS (P =0.0006, OR, 3.4; 95% confidence interval, 1.5–7.9), and EC (P =0.0344, OR, 2.8; 95% confidence interval, 1.4–5.3) had a significantly higher risk of recurrence.
Conclusion: In general, patients with CAH or early-stage EC who were treated with progesterone therapy had a favorable prognosis. However, the recurrence risk was not insignificant. Weight control is crucial for improving the clinical management of this patient group.
Keywords: endometrial cancer, complex atypical hyperplasia, fertility-sparing treatment, progestogens, systematic review