{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T04:59:09Z","timestamp":1790312349697,"version":"4.1.0"},"reference-count":66,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:00:00Z","timestamp":1789344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100015825","name":"Korea University Anam Hospital","doi-asserted-by":"publisher","award":["I2504921"],"award-info":[{"award-number":["I2504921"]}],"id":[{"id":"10.13039\/501100015825","id-type":"DOI","asserted-by":"publisher"}]},{"award":["I2504921"],"award-info":[{"award-number":["I2504921"]}],"id":[{"id":"https:\/\/ror.org\/04gjj3027","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Molecular classification (POLE-mutated, mismatch-repair\u2013deficient [MMRd], no-specific-molecular-profile [NSMP], p53-abnormal [p53abn]) is used to stratify women receiving fertility-sparing treatment (FST) for early endometrial carcinoma or atypical hyperplasia, but reported subtype differences are inconsistent. We estimated subtype-specific complete response (CR) and post-CR recurrence and examined how outcome-assessment timing (fixed early timepoint versus best response) and follow-up duration affect subtype comparisons. Methods: PubMed and Embase (January 2015\u2013August 2025) were searched; overlapping reports were consolidated; proportions were pooled with binomial\u2013normal generalised linear mixed models; late response among early non-responders was analysed in paired cohorts; recurrence was meta-regressed on follow-up; risk of bias (QUIPS) and certainty (GRADE) were assessed. Results: Twenty reports yielded 15 cohorts (10 primary). Best CR was 85% (95% CI 70\u201393) for POLE, 71% (57\u201383) for MMRd, and 85% (77\u201391) for NSMP. In six paired cohorts, CR rose from the early timepoint to best response in every subtype (MMRd 44\u219277%, NSMP 57\u219290%); 55% of MMRd and 76% of NSMP early non-responders later achieved CR, and within-cohort best CR was lower for MMRd than NSMP (odds ratio [OR] 0.36, 0.17\u20130.79). Recurrence after CR was 34% (23\u201346) for MMRd, 30% (17\u201349) for NSMP, and 19% (4\u201357; 0\u2013100% across cohorts) for POLE. NSMP recurrence tended to rise with follow-up in an exploratory study-level analysis (OR 1.02\/month; p = 0.06, dependent on the few long-follow-up cohorts), whereas MMRd recurrence did not (adjusted OR vs. NSMP 1.7, 0.9\u20133.3). p53abn tumours (n = 28) showed variable CR (17\/24) and recurrence in 9\/17. Occult p53abn or MMRd tumours affected 17% (12\u201324%; range 7\u201347%) of conventionally selected candidates. Certainty was low or very low. Conclusions: Subtype comparisons in FST depend on when outcomes are assessed and how long patients are followed. Molecular classification is prognostic, not predictive; its principal value is to identify occult higher-risk tumours and to calibrate counselling and surveillance, not to justify de-escalation.<\/jats:p>","DOI":"10.3390\/cancers18182972","type":"journal-article","created":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T14:15:04Z","timestamp":1789395304000},"page":"2972","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Fertility-Sparing Treatment of Endometrial Cancer and Atypical Endometrial Hyperplasia by Molecular Classification: A Systematic Review and Meta-Analysis Accounting for Outcome-Assessment Timing and Follow-Up Duration"],"prefix":"10.3390","volume":"18","author":[{"given":"Abeer","family":"Alatawi","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Korea University Medicine, Seoul 02841, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saleem","family":"Almaser","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Maternity and Children Hospital (MCH), Tabuk 47717, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malak","family":"Alanazi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Maternity and Children Hospital (MCH), Tabuk 47717, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amirah","family":"Alatawi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, King Fahad Specialist Hospital, Tabuk 47717, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2541-8879","authenticated-orcid":false,"given":"Seongmin","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Korea University Medicine, Seoul 02841, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,14]]},"reference":[{"key":"ref_1","first-page":"209","article-title":"Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J. 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