Conservative re‐treatment of women with atypical endometrial hyperplasia and early endometrial carcinoma: We can hope, at least

Author:

Raffone Antonio12ORCID,Raimondo Diego2,Rovero Giulia1,Travaglino Antonio34,Lopez Giovanni5,Di Maio Carlo Michele5,Neola Daniele6,Raspollini Arianna1,Renzulli Federica1,Filippelli Amelia2,Casadio Paolo2,Seracchioli Renato12,Guida Maurizio6

Affiliation:

1. Department of Medical and Surgical Sciences (DIMEC) University of Bologna Bologna Italy

2. Division of Gynecology and Human Reproduction Physiopathology IRCCS Azienda Ospedaliero‐Universitaria di Bologna Bologna Italy

3. Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine University of Naples Federico II Naples Italy

4. Gynecopathology and Breast Pathology Unit, Department of Woman's Health Science Agostino Gemelli University Polyclinic Rome Italy

5. Gynecology and Obstetrics Unit, Department of Medicine, Surgery and Dentistry "Schola Medica Salernitana" University of Salerno Baronissi Italy

6. Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine University of Naples Federico II Naples Italy

Abstract

AbstractBackgroundIn women with recurrent disease who were conservatively treated for atypical endometrial hyperplasia (AEH) and early endometrial carcinoma (EEC), the reasons why conservative treatment was chosen persist and outcomes of performing a conservative re‐treatment are unclear, as pooled estimates on oncologic outcomes of such a re‐treatment are lacking.ObjectivesTo provide pooled estimates of oncologic outcomes of conservative re‐treatment in women with recurrent AEH or EC.Search StrategyA systematic review and meta‐analysis was performed by searching six electronic databases from their inception to March 2022.Selection CriteriaStudies that allowed extraction of data about oncologic outcomes of conservative re‐treatment of women with recurrent AEH and EEC after a conservative treatment.Data Collection and AnalysisPooled prevalence of complete response (CR), poor response (PR), and recurrence after conservative re‐treatment was calculated.Main ResultsFifteen studies (12 retrospective and 3 prospective) with 492 women (42.1% AEH and 57.9% EEC) were included in the systematic review, and 10 studies (8 retrospective and 2 prospective) were suitable for the meta‐analysis. Pooled prevalence was 85.3% (95% confidence interval [CI] 77.0%–91.0%) for CR, 14.7% (95% CI 9.0%–23.0%) for PR, and 40.4% (95% CI 15.5%–71.4%) for recurrence.ConclusionsConservative re‐treatment in AEH or EC recurrent women has a high CR rate and acceptable recurrence rate that might allow it to be considered a safe and viable option, at least as a first round of conservative treatment. Women with an unsatisfied desire for motherhood or with high surgical risk might avoid hysterectomy and attempt childbearing or spare high‐risk surgery.

Publisher

Wiley

Subject

Obstetrics and Gynecology,General Medicine

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