Fertility and obstetric outcomes after fertility-sparing treatment for early-stage endometrial cancer and atypical hyperplasia: a systematic review and meta-analysis.

OBJECTIVE

To evaluate the effects of fertility-sparing treatment on reproductive and obstetric outcomes in patients diagnosed with early-stage endometrial cancer or atypical hyperplasia.

METHODS

A systematic review and meta-analysis was conducted. Literature was searched across multiple electronic databases. The risk of bias in the included studies was assessed using a modified domain-based methodology. This approach evaluated critical bias domains aligned with established systematic review tools, including selection bias, performance bias, attrition bias, detection bias, and reporting bias. Data were extracted and analyzed using R software, with evaluations of heterogeneity and publication bias.

RESULTS

Six studies comprising 337 patients were included. Progestin-based fertility-sparing treatment achieved a complete response rate of up to 94%, with pregnancy rates as high as 77% in some cohorts. Significant variation was observed across studies, with reported pregnancy rates ranging from 44.9% to 70.7% (He and colleagues, 2022). The pooled relative risk for recurrence/progression was 1.1 (95% confidence interval 0.99 to 1.23), indicating no significantly elevated risk of disease recurrence/progression with fertility-sparing treatment compared with conventional treatment. However, the studies showed a high risk of bias, particularly in randomization processes. Sensitivity analysis indicated that the findings were significantly influenced by a single study.

CONCLUSIONS

Fertility-sparing treatment shows favorable reproductive outcomes for women with early-stage endometrial cancer or atypical hyperplasia, with high response and pregnancy rates and no significantly increased risk. However, the significant risk of bias and considerable inter-study heterogeneity warrant cautious interpretation of these results. Future rigorously designed studies are needed to confirm these results and support clinical application.