Laura Pivazyan

Whether hysteroscopy contributes to intraperitoneal cell dissemination, progression and recurrence in endometrial cancer: Systematic review and meta-analysis

To assess the oncologic safety of hysteroscopy in patients with endometrial cancer by evaluating its impact on positive peritoneal cytology (PPC), disease-free survival (DFS), and overall survival (OS). This systematic review and meta-analysis adhered to PRISMA guidelines and was registered in PROSPERO (CRD42024591414). We searched PubMed, the Cochrane Library, ClinicalTrials.gov, Google Scholar, and MEDLINE for studies published through April 2025. Eligible studies enrolled women with confirmed endometrial cancer who underwent hysteroscopy. The primary outcome was PPC; secondary outcomes were DFS and OS. Pooled risk ratios (RRs) were calculated under fixed-effects models, and heterogeneity was assessed using the I The meta-analysis showed no significant difference in PPC between hysteroscopy and control groups in retrospective/prospective studies (p = 0.13) or in randomized controlled trials (p = 0.61). Twelve studies reported DFS data; pooled analysis demonstrated no significant difference between groups (RR = 0.88; 95 % CI, 0.75-1.05; p = 0.16). Heterogeneity was moderate to high (I Hysteroscopy does not significantly affect PPC, DFS, or OS in patients with endometrial cancer, supporting its oncologic safety. Future research should stratify outcomes by cancer subtype and implement standardized hysteroscopy protocols (e.g., defined examination duration and fluid pressure).

Metformin and progestins in women with atypical hyperplasia or endometrial cancer: systematic review and meta-analysis

To assess metformin's effectiveness in adding it to progestin-based hormone therapy for treating atypical endometrial hyperplasia (AEH) and early endometrial cancer (EEC). We conducted a systematic review and meta-analysis following PRISMA guidelines (registration number CRD42023399094). We searched databases for studies up to March 2023, including randomized and non-randomized clinical trials in English. Out of 280 studies, 9 studies (1104 patients) were eligible. A total of 408 patients were allocated to receive metformin, and 696 patients entered the control group. Primary analysis focused on evaluating the CR showed a significant difference in patients with AEH treated with metformin (RR = 1.10, 95% CI 1.02-1.20, p = 0.02). Relapse rate (RR = 0.62, 95% CI 0.33-1.17, p = 0.14) was also evaluated. Secondary analysis indicated higher pregnancy rates (RR = 1.28, 95% CI 1.04-1.57, p = 0.02) with no significant difference in live birth rates (RR = 0.56, 95% CI 0.29-1.10, p = 0.09). Combined therapy is effective. Metformin shows superiority to the standard regimen in achieving better CR rate in patients with AEH and benefits pregnancy rates but not recurrence or live birth rates. Therefore, the ideal fertility-sparing treatment for EC has not yet been determined and further clinical trials are needed.