Intervention Review

Adjuvant progestagens for endometrial cancer

  1. Pierre PL Martin-Hirsch1,*,
  2. Andrew Bryant2,
  3. Sarah L Keep1,
  4. Henry C Kitchener3,
  5. Richard Lilford4

Editorial Group: Cochrane Gynaecological Cancer Group

Published Online: 15 JUN 2011

Assessed as up-to-date: 9 MAY 2011

DOI: 10.1002/14651858.CD001040.pub2

Database Title

Additional Information

How to Cite

Martin-Hirsch PPL, Bryant A, Keep SL, Kitchener HC, Lilford R. Adjuvant progestagens for endometrial cancer. Cochrane Database of Systematic Reviews 2011, Issue 6. Art. No.: CD001040. DOI: 10.1002/14651858.CD001040.pub2.

Author Information

  1. 1

    Royal Preston Hospital, Lancashire Teaching Hospital NHS Trust, Gynaecological Oncology Unit, Preston, Lancashire, UK

  2. 2

    Newcastle University, Institute of Health and Society, Newcastle upon Tyne, UK

  3. 3

    St. Mary's Hospital, Academic Unit of Obstetrics and Gynaecology, University of Manchester, Manchester, UK

  4. 4

    University of Birmingham, Department of Public Health and Epidemiology, Birmingham, UK

*Pierre PL Martin-Hirsch, Gynaecological Oncology Unit, Royal Preston Hospital, Lancashire Teaching Hospital NHS Trust, Sharoe Green Lane, Fullwood, Preston, Lancashire, PR2 9HT, UK. pierre.martinhirsch@btinternet.com.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 15 JUN 2011

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Endometrial cancer is the most common genital tract carcinoma among women in developed countries, with most women presenting with stage 1 disease. Adjuvant progestagen therapy has been advocated following primary surgery to reduce the risk of recurrence of disease.

Objectives

To evaluate the effectiveness and safety of adjuvant progestagen therapy for the treatment of endometrial cancer.

Search methods

We searched the Cochrane Gynaecological Cancer Group Trials Specilaised Register, Cochrane Central Register of Controlled Trials (CENTRAL) Issue 2, 2009. MEDLINE and EMBASE up to April 2009.

Selection criteria

Randomised controlled trials (RCTs) of progestagen therapy in women who have had surgery for endometrial cancer.

Data collection and analysis

Two review authors independently abstracted data and assessed risk of bias. Risk ratios (RRs) comparing survival in women who did and did not receive progestagen were pooled in random effects meta-analyses. .

Main results

Seven trials assessing 4556 women were identified. Three trials included women with stage one disease only, whereas four included women with more advanced disease. Meta-analysis of four trials showed that there was no significant difference in the risk of death at five years between adjuvant progestagen therapy and no further treatment (RR = 1.00, 95% CI 0.85 to 1.18). This conclusion is also robust to single trial analyses at 4 and 7 years and in one trial across all points in time using a hazard ratio (HR). There was also no significant difference between progestagen therapy and control in terms of the risk of death from endometrial cancer, cardiovascular disease and intercurrent disease. Relapse of disease appeared to be reduced by progestagen therapy in one trial (HR = 0.71, 95% CI 0.52 to 0.97 and 5 year RR = 0.74, 95% CI 0.58 to 0.96), but there was no evidence of a difference in disease recurrence in another trial at 7 years (RR = 1.34, 95% CI 0.79 to 2.27).

Authors' conclusions

There is no evidence to support the use of adjuvant progestagen therapy in the primary treatment of endometrial cancer.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

No evidence to support use of adjuvant progestagens to prevent recurrence of endometrial cancer after surgery

Endometrial (womb) cancer is the most common genital tract cancer in developed countries. Progestagen (a hormone) therapy is sometimes used following initial surgery to reduce the risk of recurrence. However, progestagens have been found to reduce one of the protective factors against heart disease and may also make tumours more resistant to radiotherapy. This review found no evidence to support the use of progestagen as an addition to surgery for newly diagnosed endometrial cancer. Progestagen can, however, prevent or delay recurrence of cancer in some patients.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

Progestagens治療子宮內膜癌

在許多西方國家中，子宮內膜癌是最常見的生殖道癌症，絕大多數(大約75％)的婦女是出現第1期疾病。雖然對第1期疾病的總體未校正的5年生存率是相對較高的約75％，但是在第1期疾病有預後不良因素的婦女，其存活期望值是低於26％。輔助Progestagen的療法治療被主張使用在基本手術後，以減少疾病復發的危險。我們已經回顧這療法的有效性。

目標

Progestagen類藥物的療法已經被認為可以在首位手術治療子宮內膜癌之後，減少復發的風險。本回顧文獻的主要目標是要評估Progestagen類藥物的輔助療法的效力。

搜尋策略

我們搜尋了Cochrane Gynaecological Cancer Group trials register 和MEDLINE 直到1999年5月。

選擇標準

我們只收納以「Progestagen類藥物」治療已經接受過手術的子宮內膜癌病人的隨機性試驗。

資料收集與分析

由兩位作者者獨立進行試驗方法品質的評估及數據的摘錄。

主要結論

本回顧文獻包含6項研究，總共收錄4,351位婦女，3項研究包括只有第1階段疾病的婦女，然而其它3項研究中，包括更高階段及嚴重疾病的婦女。以5項研究為基準，顯示使用輔助Progestagen類藥物的療法不會改善總體存活期(OR 1.05，95％CI 0.88 to 1.24)，但似乎可以減少子宮內膜癌的死亡率和復發率，分別為 OR 0.88 95% CI (0.71−1.1) 和 0.81 95% CI (0.65−1.01))。不過，非子宮內膜癌相關的死亡更多見於使用Progestagens的女性，OR 1.33 (1.02−1.73)。

作者結論

現有的證據無法支持以輔助Progestagen類藥物作為子宮內膜癌的基本治療方法。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

沒有證據可支持使用Progestagen類藥物輔助療法，以防止在子宮內膜癌手術後的癌症復發。在許多西方國家中，子宮內膜癌是最常見的生殖道癌。Progestagen (一種荷爾蒙) 療法有時用在初步的手術以後，以減少復發的危險，不過，已經發現到Progestagens會降低可保護心臟疾病的其中一個保護性因子，及也可能會導致腫瘤更能抵抗放射線的治療。本次回顧文獻顯示沒有任何證據，可支持Progestagen可作為子宮內膜癌的新病人除手術外的附加療法。不過Progestagen能夠使縮小一些癌症患者的復發病灶。

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