Oncologic and Reproductive Outcomes of Fertility-Sparing Management in Early-Stage Endometrial Carcinoma: A Systematic Review and Meta-Analysis
by
, , , , , , ,
Pál Sebok
1,†
,
Márton Keszthelyi
1,*,†
,
Balázs Vida
1,
Lotti Lőczi
1,2,
Barbara Sebők
2,
Petra Merkely
1,
Nándor Ács
1,
Ferenc Bánhidy
1,
Attila Keszthelyi
3,
Szabolcs Várbíró
2,4,
Balázs Lintner
1,‡ and
Richárd Tóth
1,‡ 1
Department of Obstetrics and Gynecology, Semmelweis University, 1082 Budapest, Hungary
2
Workgroup of Research Management, Doctoral School, Semmelweis University, 1085 Budapest, Hungary
3
Department of Urology, Semmelweis University, 1082 Budapest, Hungary
4
Department of Obstetrics and Gynecology, University of Szeged, 6725 Szeged, Hungary
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
‡
These authors also contributed equally to this work.
Cancers 2026, 18(3), 399; https://doi.org/10.3390/cancers18030399
Submission received: 20 December 2025
/
Revised: 12 January 2026
/
Accepted: 26 January 2026
/
Published: 27 January 2026
(This article belongs to the Special Issue Gynecological Cancer: Prevention, Diagnosis, Prognosis and Treatment)
Simple Summary
Early-stage endometrial cancer is increasingly diagnosed in young women who wish to preserve their fertility, even though standard treatment involves removal of the uterus. Conservative, fertility-sparing treatments using hormonal therapy or minimally invasive surgery have therefore been developed, but their long-term effectiveness and reproductive success remain uncertain. We reviewed and analyzed data from 76 studies including more than 2500 women with early-stage endometrial cancer treated conservatively. Overall, approximately 70–75% of women achieved an initial remission with fertility-sparing treatment, although cancer recurrence occurred in about 30–35% of those who responded. Strategies combining hormonal therapy with hysteroscopic removal of visible disease were associated with higher remission durability and lower rates of early treatment failure compared with hormonal treatment alone. Following remission, conception occurred in approximately 45–50% of women attempting pregnancy, while 35–40% resulted in live births. Together, these findings illustrate both the potential benefits and the inherent limitations of fertility-sparing treatment and may help support realistic counseling and individualized clinical decision-making.
Excerpt
Note: In lieu of an abstract, this is an excerpt from the first page.
Endometrial carcinoma (EC) is the leading gynecologic malignancy in high-income countries, with a consistent upward trend in incidence observed among younger women, particularly in those younger than 50 years [...]
