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Maintenance Therapy for Preventing Endometrioma Recurrence after Endometriosis Resection Surgery-A Systematic Review and Network Meta-analysis

OBJECTIVE

To evaluate the efficacy of different hormone therapies in preventing postoperative endometrioma recurrence.

DATA SOURCES

The MEDLINE, COCHRANE and Embase electronic databases were searched from inception to 30 April 2021.

METHODS OF STUDY SELECTION

Randomized, controlled trials (RCTs) or cohort studies including reproductive age women with endometriosis undergoing ovarian cystectomy or excision of endometriotic lesions compared the effects of postoperative adjuvant therapy [gonadotropin-releasing hormone agonist (GnRHa)] and postoperative maintenance hormone interventions for more than one year [i.e., oral contraceptive pills (OCPs), dienogest (DNG), levonorgestrel-releasing intrauterine system (LNGIUS)] on endometrioma recurrence .

TABULATION, INTEGRATION AND RESULTS

Data collection and analysis of the data were independently performed by two reviewers. A total of 11 studies were included, of which 2 were RCTs, and 9 were cohort studies. There were 2394 patients with 6 interventions (cases: 1665, 69.6%) and expectant management (cases: 729, 30.4%). Relative treatment effects were estimated using network meta-analysis (NMA) and ranked in descending order. The clinical effectiveness of these drugs (versus expectant management) was as follows: GnRHa plus DNG [odds ratio (OR), 0.04; 95% confidence interval (CI), 0.01-0.27], surface under the cumulative ranking (SUCRA)= 94.0; DNG (OR, 0.11; 95% CI, 0.04-0.32), SUCRA= 69.7; GnRHa plus OCP (OR, 0.12; 95% CI, 0.02-0.64), SUCRA= 63.4; GnRHa plus LNGIUS (OR, 0.13; 95% CI, 0.03-0.66), SUCRA= 59.4; and OCP (OR, 0.21; 95% CI, 0.13-0.36), SUCRA= 43.6. The effectiveness of GnRHa (OR, 0.47; 95% CI, 0.12-1.89), SUCRA= 17.3 was not significantly different from that of controls.

CONCLUSION

In NMA, combined postoperative adjuvant therapy and longer maintenance hormone treatment are better than a single agent in preventing postoperative endometrioma recurrence. GnRHa plus DNG maintenance treatment might be the most effective intervention. Large-scale RCTs of these agents are still required.

REGISTRATION OF SYSTEMATIC REVIEWS

Date of PROSPERO registration: 17 April 2021.

PROSPERO REGISTRATION NUMBER

CRD42021247291.

Evidence from three cohort studies on the expression of MUC16 around the time of implantation suggests it is an inhibitor of implantation

PURPOSE

To examine the expression of MUC16 in the endometrium peri-implantation period in three different cohort studies.

METHODS

This was a retrospective observational cohort study. A total of 245 participants were recruited in three separate cohort studies: (1) women with recurrent miscarriage (n = 50) and fertile controls (n = 29); (2) women who had high (n = 20) or normal (n = 20) progesterone on the day of hCG trigger in ovarian stimulation cycle for IVF; and (3) women who did (n = 95) or did not (n = 31) conceive following frozen embryo transfer in HRT cycles. All subjects had archived endometrial samples precisely taken on LH+7 in natural cycles, or hCG+6 in ovarian stimulation cycles, or P+5 in HRT cycles. The H-score (median, range) of MUC16 in the luminal epithelium and glandular epithelium was determined by using immunohistochemistry.

RESULTS

The median (range) of H-score of MUC16 in the luminal epithelium (1) in women with recurrent pregnancy loss was 23.7 (0-300), which was significantly (P < 0.05) lower than that of 118.4 (7.7-300) in fertile controls; (2) in women with elevated progesterone on the day of hCG administration (147.8, 18.0-230.1), significantly (P < 0.05) higher than that of women with normal progesterone (61.0, 2.3-205.3); (3) in women who conceived (23.1, 0-250.3), significantly (P < 0.001) lower than that in women who did not conceive (58.4, 0-300).

CONCLUSION

The expression of MUC16 in all three cohort studies is consistent with it being an inhibitor of implantation.