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Meta-Analysis
. 2020 Apr 28;15(4):e0232231.
doi: 10.1371/journal.pone.0232231. eCollection 2020.

Concurrent and future risk of endometrial cancer in women with endometrial hyperplasia: A systematic review and meta-analysis

Michelle T Doherty  1 , Omolara B Sanni  1 , Helen G Coleman  1   2 , Chris R Cardwell  1 , W Glenn McCluggage  3 , Declan Quinn  4 , James Wylie  4 , Úna C McMenamin  1
Affiliations
Meta-Analysis

Concurrent and future risk of endometrial cancer in women with endometrial hyperplasia: A systematic review and meta-analysis

Michelle T Doherty et al. PLoS One. .

Abstract

Background: To inform treatment decisions in women diagnosed with endometrial hyperplasia, quantification of the potential for concurrent endometrial cancer and the future risk of progression to cancer is required.

Methods: We identified studies up to September 2018 that reported on the prevalence of concurrent cancer (within three months of endometrial hyperplasia diagnosis), or the incidence of cancer, identified at least three months after hyperplasia diagnosis. Random-effects meta-analyses produced pooled estimates and 95% confidence intervals (CIs).

Results: A total of 36 articles were identified; 15 investigating concurrent and 21 progression to cancer. In pooled analysis of 11 studies of atypical hyperplasia, the pooled prevalence of concurrent endometrial cancer was 32.6% (95% CI: 24.1%, 42.4%) while no studies evaluated concurrent cancer in non-atypical hyperplasia. The risk of progression to cancer was high in atypical hyperplasia (n = 5 studies, annual incidence rate = 8.2%, 95% CI 3.9%, 17.3%) and only one study reported on non-atypical hyperplasia (annual incidence rate = 2.6%, 95% CI: 0.6%, 10.6%).

Conclusions: Overall, a third of women with atypical hyperplasia had concurrent endometrial cancer, although the number of studies, especially population-based, is small. Progression to cancer in atypical hyperplasia was high, but few studies were identified. Population-based estimates are required, in both atypical and non-atypical hyperplasia patients to better inform treatment strategies.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram of study selection for the systematic review of prevalence of concurrent and risk of future endometrial cancer among patients with endometrial hyperplasia.
*Two articles outlined in the supplementary material did not meet the criteria for inclusion in the concurrent endometrial cancer investigation but were included in the review as they met the inclusion criteria for the incident endometrial cancer investigation. EC = endometrial cancer, EH = endometrial hyperplasia.
Fig 2
Fig 2. Forest plot of proportion of concurrent endometrial cancer diagnosed within three months of endometrial hyperplasia diagnosis.
Fig 3
Fig 3. Forest plot of incidence rates of endometrial cancer diagnosed after three months of endometrial hyperplasia diagnosis.
aPremenopausal women, bPostmenopausal women, cLNG-IUS (levonorgestrel intrauterine system) treated group, dOral progesterone-treated group.
See this image and copyright information in PMC

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