A Meta-analysis Of Endometrial Carcinoma Of Stage IA In Treatment Of Fertility-preserving

Objectives:To investigate the efficacy of fertility-sparing treatment to achieve pathological complete response(CR) in patients with early endometrial adenocarcinoma(EC),Such as: progestin therapy only, Levonorgestrel releasing intrauterine system therapy or combined with Gn RH-a therapy or progestin therapy, hysteroscopic resection of lesions and endometrium(or muscular) + mirena treatment,or progestin treatment, evaluate the effect of different fertility-preserving treatments from Complete remission rate, recurrence rate and pregnancy rate after treatment. Methods:Use a computer to retrieve Pubmed, Medline, Web of Science, OVID,CNKI, wanfang database, China biological medicine, Vip datebase for 2000 to March 2016,collect all the researsh of fertility-sparing treatment of stage IA endometrial carcinoma(high differentiation of endometrial adenocarcinoma, confirmed by pathology for estrogen dependent type I, with the exception of special types such as serous carcinoma, mucinous carcinoma and clear cell carcinoma, etc.),read all the full text of literature collection, excluding those not in conformity with the purpose of this paper study or do not conform to the requirements of the quality of the article, use the systemic evaluation of The Cochrane Collaboration to screening the literature,and use R3.2.2 software for analyzing all the choosen articles. Results:Twenty-nine studies met the selection criteria. a total of 618 patients into the research, 453 patients use progestin only,74 patients use hysteroscopic of lesions and Endometrial or muscular layer at the bottom of the lesions combined with hormone therapy, 91 patients use Levonorgestrel releasing intrauterine system therapy or combined with Gn RH-a therapy or progestin therapy, use the soft R3.2.2 to analysis the data. According to the result, The complete response rate and 95% confidence interal of Simple use of progesterone as the treatment of early endometrial cancer is 0.8176 [0.7754, 0.8567];The recurrence rate and 95% confidence interal after complete response is 0.2569 [0.2027;0.3146];The rate of pregnancy through assisted reproductive technology and 95% confidence interal after complete remission is 0.8406 [0.7599, 0.9298]; Natural pregnancy rate and 95% confidence interal is 0.3565 [0.2696, 0.4478]. The rate and 95% confidence interal of hysteroscopic of lesions and Endometrial or muscular layer at the bottom of the lesions with hormone therapy is 0.9818 [0.9025; 1];The recurrence rate and 95% confidence interal after complete response is 0.0551[0.0022;0.1461];The rate of pregnancy and 95% confidence interal after complete remission is 0.5615 [0.4087;0.7097]. The complete response rate of using Levonorgestrel releasing intrauterine system therapy or combined with Gn RH-a therapy or progestin therapy and 95% confidence interal is 0.7029 [0.5978;0.7994];The recurrence rate and 95% confidence interal after complete response is 0.0461[5e-04; 0.1318]; The rate of pregnancy and 95% confidence interal after complete remission is 0.4482 [0.0296;0.9123]. Conclusions:The available evidence suggests that treatment with oral progestin or hysteroscopic surgery or LNG-IUS therapy combined with progesterone are all effective. The Risk of disease progression during treatment is very small, but the possibility of recurrence after complete remission is exist, so long-term follow-up is necessary. As for the current literature of conservative treatment are based on small sample clinical study or clinical analysis, a large number of controlled clinical trials are needed to compare the curative effect of the different treatment.