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

Background: 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.