Fertility-Sparing Management of Atypical Hyperplasia and Endometrial Cancer from the Perspective of Molecular and Hormonal Profiles: A Meta-Analysis-Driven Framework
TL;DR
Findings support biologically stratified selection for fertility-sparing management for EC and AH, with p53-abnormal and deficient mismatch repair tumours significantly associated with lower complete remission (CR) rates compared with other subgroups.
Abstract
Simple Summary Molecular classification has become central in decision-making for fertility-sparing management of atypical hyperplasia (AH) and endometrial cancer (EC), although its prognostic and predictive values remain incompletely defined. We performed a systematic review and meta-analysis to determine the association between tumour profiles and oncologic outcomes in reproductive-aged women undergoing conservative treatment. Eighteen studies were included after searches of databases up to July 2026. p53-abnormal (p53abn) and deficient mismatch repair (dMMR) tumours were significantly associated with lower complete remission (CR) rates compared with other subgroups. In contrast, no specific molecular profile (NSMP) tumours were associated with higher odds of CR. POLE-mutated (POLEmut) tumours showed CR rates comparable to NSMP without significant differences. Progesterone receptor (PR) positivity was strongly associated with CR. These findings support biologically stratified selection for fertility-sparing management for EC and AH.