PhD Scientific Days 2026

Pathological and Oncological Sciences 1.

Oncologic Safety and Reproductive Outcomes of Fertility-Sparing Treatment in Early-Stage Endometrial Carcinoma: A Systematic Review and Meta-Analysis

Name of the presenter

Sebok, Pál Szabolcs

Institute/workplace of the presenter

Department of Obstetrisc and Gynecology

Authors

Sebok Pál Szabolcs¹
1: Deparatment of Obstetrics and Gynecology, Semmelweis University

Text of the abstract

Introduction
Early-stage endometrial carcinoma is increasingly diagnosed in women of reproductive age. While standard treatment involves hysterectomy, fertility-sparing approaches have emerged as alternatives, though their long-term oncologic safety and reproductive success remain debated.

Aims
To evaluate oncologic and reproductive outcomes of fertility-sparing treatments and to identify strategies that provide the optimal balance between disease control and fertility preservation.

Methods
A systematic review and meta-analysis was conducted according to PRISMA guidelines, including studies up to April 2025. Women with FIGO stage IA endometrial carcinoma undergoing conservative treatment were eligible. Outcomes included complete response (CR), recurrence, partial and no response, pregnancy, and live birth rates. Random-effects meta-analyses and subgroup analyses by treatment modality were performed.

Results
Seventy-six studies involving 2507 patients were included. The pooled CR rate was 74%, while recurrence occurred in 35% of responders. Monotherapy with oral progestins achieved a CR rate of 72%, whereas levonorgestrel-releasing intrauterine device (LNG-IUD) monotherapy showed lower response rates. Combination strategies, particularly those incorporating hysteroscopic resection, demonstrated superior outcomes, with CR rates reaching 85% and recurrence rates reduced to 14–16%. Early treatment failure remained notable, with partial and no response rates of 6% and 16%, respectively. Reproductive outcomes were moderate: the pooled pregnancy rate was 48%, and the live birth rate was 36%. Combination approaches yielded more consistent reproductive success compared to monotherapy.

Conclusion
Fertility-sparing management in early-stage endometrial carcinoma achieves high initial remission rates but is limited by substantial recurrence risk and moderate reproductive success. Evidence suggests that combined treatment strategies, especially those including hysteroscopic resection, offer improved oncologic control and fertility outcomes. Careful patient selection, close surveillance, and individualized counseling are essential.

Funding
This research was conducted within a PhD scholarship program and received no specific external funding.