Prolonged conservative treatment of women with atypical endometrial hyperplasia and early endometrial carcinoma: A systematic review and meta-analysis

AbstractBackground In women with atypical endometrial hyperplasia or early endometrial carcinoma, a maximum duration of conservative treatment of 15 months is recommended. However, some studies have reported promising results for treatment lasting far in excess of 12 months. Evidence remains poor. Objectives To provide pooled estimates of oncological outcomes of prolonged conservative treatment (lasting > 12 months) in women with atypical endometrial hyperplasia or early endometrial carcinoma. Search strategy A systematic review and meta-analysis was performed by searching six electronic databases from their inception to November 2024. Selection criteria Studies that reported data on oncological outcomes of prolonged conservative treatment of women with atypical endometrial hyperplasia and early endometrial carcinoma. Data collection and analysis Pooled rates for complete response, poor response, progressive disease and recurrence following prolonged conservative treatment were calculated for each included study and as pooled estimates, with 95% confidence intervals (CI). Results Ten studies with 846 women (361 atypical endometrial hyperplasia and 485 early endometrial carcinoma) were included. The pooled rates were 58% (95% CI 38.0–78%) for complete response, 26% (95% CI 17–36%) for poor response, 1% (95% CI 0–5%) for progressive disease, and 33% (95% CI 18–49%) for recurrence. Conclusion In women with atypical endometrial hyperplasia or early endometrial carcinoma, conservative treatment for > 12 months may represent a feasible option in carefully selected patients under strict surveillance, with a complete response in more than half of patients and a relatively low risk of progressive disease and recurrence. PROSPERO Registration Number CRD42024609258.