治疗IA期子宫内膜癌的孕育能力保护疗法:系统性审查和元分析
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Yukio Suzuki1, Jennifer S Ferris2, Ling Chen3
1Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY; Department of Gynecology, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan.
American journal of obstetrics and gynecology
|July 20, 2024
概括
在早期子宫内膜癌的治疗中,Levonorgestrel释放子宫内膜器 (LNG-IUD) 的完全反应率高于口服孕激素. 这一元分析有助于做出可保护生育能力的治疗决定.
科学领域:
- 妇科瘤学 妇科瘤学
- 生殖医学 生殖医学
- 基于证据的医学基于证据的医学.
背景情况:
- 保护生育能力的治疗方法越来越多地用于生育年龄患者的早期子宫内膜癌.
- 需要比较口服孕激素和levonorgestrel释放子宫内装置 (LNG-IUD) 的强有力的证据.
研究的目的:
- 系统地审查和分析口服孕激素与LNG-IUD在早期子宫内膜癌中保护生育能力的结果.
- 为了比较这两种主要的基于孕激素的疗法的有效性.
主要方法:
- 观察性研究和随机对照试验的系统审查和元分析.
- 在5个数据库和1个试验注册表中进行文献搜索,截至2024年4月16日.
- 进行比例元分析以估计1年内完全响应 (CR) 率;进行了灵敏度分析和偏差风险评估.
主要成果:
- 分析包括754名患者:490人服用口服孕激素,264人使用LNG-IUD.
- 在12个月内汇集的CR率:口服孕激素的66% (95% CI,55-76) 与LNG-IUD的86% (95% CI,69-95).
- 经过调整后,LNG-IUD与口服孕激素 (66%) 相比,CR率更高 (89%),异质性降低. 口服孕激素的联合怀孕率为58%,LNG-IUD的怀孕率为44%.
结论:
- 与口服孕激素相比,LNG-IUD在早期子宫内膜癌的12个月内显示出更高的完整反应率.
- 研究结果支持为希望保持生育能力的患者做出个性化治疗决策.
- 这两种治疗都提供了具有不同功效的生育保护选择.
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