Endometrial polypoid adenomyoma outcomes and fertility-sparing treatments efficacy for atypical type: A systematic review and network meta-analysis

doi:10.5306/wjco.123273

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World Journal of Clinical Oncology

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2218-4333

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Meta-Analysis

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Clin Oncol. Oct 24, 2026; 17(10): 123273
Published online Oct 24, 2026. doi: 10.5306/wjco.123273

Endometrial polypoid adenomyoma outcomes and fertility-sparing treatments efficacy for atypical type: A systematic review and network meta-analysis

Jie-Zhuang Huang, Xia Liu, Ya-Wen Deng, Cai-Ni Wei, Shu-Li Tang, Zhi-Fu Zhi

Jie-Zhuang Huang, Ya-Wen Deng, Cai-Ni Wei, Shu-Li Tang, Zhi-Fu Zhi, Department of Gynecology, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China

Xia Liu, Department of Gynecology and Obstetrics, Guangxi International Zhuang Medicine Hospital, Nanning 530001, Guangxi Zhuang Autonomous Region, China

Author contributions: Huang JZ was responsible for drafting the manuscript; Liu X worked for data curation and formal analysis; Deng YW and Wei CN were devoted to data collection and curation; Tang SL was accountable for investigation and formal analysis; Zhi ZF taken protocol design, project administration, and review and editing writing; the manuscript has been read and approved by all the authors and the authorship as stated earlier in this document have been met; and each author believes that the manuscript represents honest work.

AI contribution statement: No AI tool was used to generate research data, interpret results, or formulate conclusions.

Conflict-of-interest statement: There are no conflicts of interest to declare.

PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.

Corresponding author: Zhi-Fu Zhi, MD, Department of Gynecology, The First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning 530021, Guangxi Zhuang Autonomous Region, China. zhizhifu525@163.com

Received: May 14, 2026
Revised: July 15, 2026
Accepted: September 24, 2026
Published online: October 24, 2026
Processing time: 161 Days and 21.7 Hours

Abstract

BACKGROUND

Endometrial polypoid adenomyoma is a kind of estrogen-dependent benign tumor, categorizing into typical [typical polypoid adenomyoma (TPA)] and atypical polypoid adenomyoma (APA). APA primarily occurs in reproductive-aged women and has malignant potential. However, the clinical outcomes between TPA and APA, and efficacy of fertility-sparing treatments for APA are lack of consensus.

AIM

To investigate distinction of clinical outcomes between TPA and APA, and assess the effectiveness of different fertility-sparing treatments for APA.

METHODS

This systematic review included randomized controlled trials and observational studies via searching seven public databases. Conventional meta-analysis was conducted by pairwise comparison of clinical outcomes between APA and TPA. The Bayesian network meta-analysis was performed for evaluating the efficacy of different fertility-sparing therapies in APA. Pooling effect sizes were calculated as odds ratio (OR) with 95% confidence interval (95%CI). Surface under the cumulative ranking curve (SUCRA) values were used to rank efficacy of different fertility-sparing treatments for each outcome in APA.

RESULTS

This study compared 773 patients with TPA to 357 patients with APA. The network meta-analysis examined an additional 400 patients diagnosed with APA only. Results showed that patients with APA had a higher incidence of synchronous endometrial hyperplasia and endometrial cancer than those with TPA, but recurrence rates were similar across both groups. Medroxyprogesterone acetate at 10 mg daily after transcervical resection of polyps (TCRP) was most effective in achieving complete response (vs TCRP: OR = 7.15, 95%CI: 1.47-34.71, SUCRA = 78.3%) and reducing recurrence in APA (vs TCRP: OR = 6.29, 95%CI: 1.28-30.84, SUCRA = 65.3%). High-dose progestin therapy after TCRP showed potential in preventing endometrial cancer (SUCRA = 73.1%) in patients with APA but did not significantly outperform TCRP.

CONCLUSION

APA was linked to a greater malignant risk than TPA. Progestin-based therapy post-TCRP may prevent recurrence, endometrial cancer progression, and achieve complete response in APA patients.

Keywords: Atypical polypoid adenomyoma; Typical polypoid adenomyoma; Fertility-sparing management; Hysteroscopy; Progestin-based treatment

Core Tip: Atypical polypoid adenomyoma (APA) carries a significantly higher risk of concurrent endometrial hyperplasia and cancer than typical polypoid adenomyoma. In this first network meta-analysis comparing fertility-sparing treatments for APA, transcervical resection of polyps (TCRP) followed by medroxyprogesterone acetate (10 mg/day) proved most effective for achieving complete response and preventing recurrence. Additionally, TCRP with subsequent high-dose progestin was most effective for preventing cancer progression. These findings provide critical evidence-based guidance for managing APA in reproductive-aged women.