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Efficacy of High-Intensity Focused Ultrasound Combined With GnRH-a for Adenomyosis: A Systematic Review and Meta-Analysis - PubMed

  • ️Fri Jan 01 2021

Meta-Analysis

Efficacy of High-Intensity Focused Ultrasound Combined With GnRH-a for Adenomyosis: A Systematic Review and Meta-Analysis

Li-Li Pang et al. Front Public Health. 2021.

Abstract

Objective: High-intensity focused ultrasound (HIFU) is an innovative non-invasive technology used for adenomyosis. Gonadotropin-releasing hormone agonist (GnRH-a) is a hormone commonly used for adenomyosis. We investigated and assessed the efficacy of HIFU combined with GnRH-a for adenomyosis. Methods: For this systematic review and meta-analysis, we searched Pubmed, Cochrane Library, Web of Science, Embase, CNKI, WanFang, and VIP databases for relevant articles published in Chinese or English that compared HIFU combined with GnRH-a vs. HIFU alone in patients with adenomyosis. The last literature search was completed on January 31, 2021. Two reviewers independently assessed study eligibility and assessed risk of bias. Another two reviewers extracted the data. The RevMan5.3 software was used for the data analysis. Changes in volume of the uterine and adenomyotic lesion were defined as the primary outcomes. The secondary outcomes were visual analog scale (VAS) scores for dysmenorrhea, menstrual volume scores, serum CA125 levels, and recurrence rate. This study is registered with PROSPERO (CRD42021234301). Results: Three hundred and ninety potentially relevant articles were screened. Nine studies with data for 766 patients were finally included. Compared with the HIFU alone group, the HIFU combined with GnRH-a group had a higher rate of uterine volume reduction (MD 7.51, 95% CI 5.84-9.17, p < 0.00001), smaller adenomyotic lesion volume (MD 4.11, 95% CI 2.93-5.30, p < 0.00001), lower VAS score for dysmenorrhea (MD 1.27, 95% CI 0.54-2.01, p = 0.0007) and menstrual volume score (MD 0.88, 95% CI 0.73-1.04, p < 0.00001), and lower CA125 level (SMD 0.31, 95% CI 0.05-0.56, p = 0.02) after the procedure. The recurrence rate in the HIFU combined with GnRH-a group was lower than that in the HIFU alone group (RR 0.28, 95% CI 0.10-0.82, p = 0.02). Conclusions: Compared with HIFU treatment alone, HIFU combined with GnRH-a for the treatment of adenomyosis has greater efficacy in decreasing the volumes of the uterine and adenomyotic lesions and alleviating symptoms. However, since the number of the included studies was too small and most of them were written in Chinese, this conclusion needs to be referenced with caution. And the long-term evidence of its efficacy is still insufficient. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/ identifier [CRD42021234].

Keywords: GnRH-a; adenomyosis; gonadotropin-releasing hormone agonist; high-intensity focused ultrasound; meta-analysis.

Copyright © 2021 Pang, Mei, Fan, Zhao, Li and Wen.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1

Flow diagram showing selection of articles for this systematic review.

Figure 2
Figure 2

Review authors' judgements about each risk of bias item for each of included study.

Figure 3
Figure 3

Review authors' judgements about each risk of bias item presented as percentages across all included study.

Figure 4
Figure 4

Meta-analysis of uterine volume changes in two groups.

Figure 5
Figure 5

Meta-analysis of lesion volume changes in two groups.

Figure 6
Figure 6

Meta-analysis of visual analog scale (VAS) scores of dysmenorrhea in two groups.

Figure 7
Figure 7

Sensitivity analysis of visual analog scale (VAS) scores of dysmenorrhea in two groups.

Figure 8
Figure 8

Meta-analysis of menstrual volume scores in two groups.

Figure 9
Figure 9

Meta-analysis of serum CA-125 levels in two groups.

Figure 10
Figure 10

Meta-analysis of recurrence rate in two groups.

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