Background: Atypical endometrial hyperplasia is a precursor of endometrial carcinoma, increasingly diagnosed in reproductive-aged women. Standard hysterectomy may constitute overtreatment. Fertility-sparing approaches, oral or local progestins, hysteroscopic resection, and combined regimens are widely used, though evidence largely derives from early-stage carcinoma.Methods: CENTRAL, EMBASE, Scopus, Web of Science, and PubMed were searched from inception to 13 April 2025. Eligible studies included premenopausal women with AEH treated with oral progestins, levonorgestrel intrauterine devices (LNG-IUDs), hysteroscopic resection, or combination regimens (e.g., oral progestins + metformin, LNG-IUD + GnRH analogues). Random-effects meta-analyses with multilevel modeling were applied. Risk of bias was assessed using RoB-2 and ROBINS-I; certainty of evidence was graded with GRADE-PRO.Results: Forty-nine studies (2313 women) were included. The pooled complete response (CR) rate was 85% (95% CI 80–89%). LNG-IUDs resulted in 88% CR and oral progestins in 80%. Combination therapies achieved up to 95% CR, though data were limited. Hysteroscopic resection combined with hormonal therapy reported high CR rates (96–97%) but relied on small, heterogeneous cohorts with uncertain reproducibility. The pooled recurrence rate was 19% (95% CI, 13–25%), lower with LNG-IUDs (14%) compared with oral progestins (22%). No response occurred in 14% overall and was lower with LNG-IUDs (13%) than oral progestins (19%). Among women attempting conception, the pooled pregnancy rate was 41%, and the live birth rate was 30%. The mean time to achieve CR was 5.6 months, whereas the mean time to recurrence was approximately 33 months.Conclusions: LNG-IUDs provide the most effective and well-supported fertility-sparing treatment for AEH, ensuring high remission with low recurrence. Despite favorable numerical outcomes, the evidence for hysteroscopic resection is limited and inconsistent, not supporting its routine use. Combination regimens may improve response but require confirmation in larger studies.
背景：非典型子宫内膜增生是子宫内膜癌的癌前病变，在育龄期女性中的诊断日益增多。标准的子宫切除术可能构成过度治疗。保留生育功能的治疗方案，包括口服或局部孕激素、宫腔镜切除术以及联合方案已被广泛应用，尽管相关证据主要来源于早期癌变研究。 方法：检索CENTRAL、EMBASE、Scopus、Web of Science和PubMed数据库，时间范围从建库至2025年4月13日。纳入的研究对象为接受口服孕激素、左炔诺孕酮宫内节育系统、宫腔镜切除术或联合方案（如口服孕激素+二甲双胍、LNG-IUD+GnRH类似物）治疗的绝经前非典型子宫内膜增生女性患者。采用多水平模型的随机效应进行荟萃分析。使用RoB-2和ROBINS-I工具评估偏倚风险，证据质量通过GRADE-PRO分级。 结果：共纳入49项研究（2313名女性）。汇总的完全缓解率为85%（95% CI 80–89%）。左炔诺孕酮宫内节育系统组完全缓解率为88%，口服孕激素组为80%。联合疗法的完全缓解率最高可达95%，但相关数据有限。宫腔镜切除术联合激素治疗的完全缓解率较高（96–97%），但基于的研究样本量小、异质性强，且结果可重复性不确定。汇总的复发率为19%（95% CI, 13–25%），左炔诺孕酮宫内节育系统组（14%）低于口服孕激素组（22%）。总体无缓解率为14%，左炔诺孕酮宫内节育系统组（13%）低于口服孕激素组（19%）。在有生育意愿的女性中，汇总的妊娠率为41%，活产率为30%。达到完全缓解的平均时间为5.6个月，而平均复发时间约为33个月。 结论：左炔诺孕酮宫内节育系统为非典型子宫内膜增生提供了最有效且证据最充分的保留生育功能治疗方案，能确保高缓解率和低复发率。尽管宫腔镜切除术在数值上显示出良好结果，但相关证据有限且不一致，不支持其常规应用。联合方案可能提高缓解率，但需在更大规模的研究中进一步证实。
肿瘤(癌症)患者之家