Background We conducted a systematic review and meta-analysis to examine outcomes of patients with endometrial intraepithelial neoplasia (EIN) treated with oral progestins or levonorgestrel-releasing intrauterine device (LNG-IUD). Methods We conducted a systematic review across five databases to examine outcomes of progestational treatment (oral progestins or LNG-IUD) for patients with EIN. The primary outcome was the best complete response (CR) rate within twelve months of primary progestational treatment. Sensitivity analyses were performed by removing studies with extreme effect sizes. Secondary outcomes included the pooled pregnancy rate. Results We identified 21 eligible studies, including 824 premenopausal patients with EIN, for our meta-analysis. Among these, 459 patients received oral progestin, while 365 patients received LNG-IUD as a primary progestational treatment. The pooled best CR proportion within 12 months was 82% (95% CI, 69-91) following oral progestin treatment, and 95% (95% CI, 81-99) following LNG-IUD treatment. After removing outlier studies, the pooled proportion was 86% (95% CI, 75-92) for the oral progestin group, and 96% (95% CI, 91-99) for the LNG-IUD group, with reduced heterogeneity. The pooled pregnancy rate was 50% (95% CI, 35-65) after oral progestin and 35% (95% CI, 23-49) after LNG-IUD treatment. Conclusions This meta-analysis provides data on the effectiveness of oral progestins and LNG-IUD treatment within 12 months of treatment among premenopausal patients with EIN. Although based on small numbers, the rate of pregnancy after treatment is modest. These data may be beneficial for selecting progestational therapies that allow fertility preservation for patients with EIN.

中文翻译：

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左炔诺孕酮宫内缓释装置治疗与口服孕激素治疗对子宫内膜上皮内瘤变育龄患者的系统评价和荟萃分析

背景我们进行了系统回顾和荟萃分析，以检查接受口服孕激素或左炔诺孕酮宫内节育器（LNG-IUD）治疗的子宫内膜上皮内瘤变（EIN）患者的结局。方法 我们对五个数据库进行了系统评价，以检查 EIN 患者孕激素治疗（口服孕激素或 LNG-IUD）的结果。主要结局是主要孕治疗十二个月内的最佳完全缓解（CR）率。通过删除具有极端效应量的研究来进行敏感性分析。次要结局包括汇总妊娠率。结果 我们确定了 21 项符合条件的研究，包括 824 名患有 EIN 的绝经前患者，用于我们的荟萃分析。其中，459 名患者接受口服孕激素，365 名患者接受 LNG-IUD 作为主要孕激素治疗。口服孕激素治疗后 12 个月内的汇总最佳 CR 比例为 82%（95% CI，69-91），LNG-IUD 治疗后为 95%（95% CI，81-99）。去除异常研究后，口服孕激素组的汇总比例为 86%（95% CI，75-92），LNG-IUD 组的汇总比例为 96%（95% CI，91-99），异质性降低。口服孕激素后的汇总妊娠率为 50%（95% CI，35-65），LNG-IUD 治疗后的汇总妊娠率为 35%（95% CI，23-49）。结论 这项荟萃分析提供了绝经前 EIN 患者治疗 12 个月内口服孕激素和 LNG-IUD 治疗有效性的数据。尽管数量较少，但治疗后的怀孕率并不高。这些数据可能有助于选择能够保留 EIN 患者生育能力的孕疗法。