The safety of fertility preservation for microinvasive cervical adenocarcinoma: a meta-analysis and trial sequential analysis.
子宮頸微浸潤腺癌保留生育功能治療安全性評價：薈萃分析和試驗序貫分析。
Ying Feng, Zihan Zhang, Tong Lou, Shuzhen Wang, Huimin Bai and Zhenyu Zhang
奉穎 張紫寒 婁彤 王淑珍 白會敏 張震宇
翻譯：奉穎 審校：白會敏
文獻摘要：
PURPOSE:This study sought to evaluate the safety of conservative treatment in the management of patients with microinvasive cervical adenocarcinoma.
METHODS: The PubMed, PMC, EMBASE, Web of Science and Cochrane databases were searched to collect correlational studies published in English between January 1949 and May 2018. Series reports that evaluating the oncological prognoses of patients with microinvasive cervical adenocarcinoma who were treated with fertility-sparing surgery versus hysterectomy were pooled for meta-analysis and trial sequential analysis.
RESULTS: A total of 8 articles with 1256 patients were collected, including 7 retrospective reviews and 1 prospective study. Only one (0.08%) patient had parametrial involvement. Positive margins of surgical specimens were identified in 6 patients (2.2%). Lymph node metastasis was found in 5 patients (0.4%). The progression-free survival and overall survival rates were 99.3 and 98.2%. Fertility-sparing surgery had no adverse impact on recurrence or survival (P = 0.524 and 0.485, respectively). Regarding potential selection bias, significantly more patients with stage IA2 tumors than those with stage IA1 disease were treated with hysterectomy (P < 0.001). The trial sequential analysis indicated that the cumulative number of patients failed to meet the required sample size (number of patients).
CONCLUSIONS:The prognosis for patients with microinvasive cervical adenocarcinoma is excellent. Fertility preservation is at least appropriate for young women with stage IA1 adenocarcinoma. Further studies are still warranted to evaluate the safety of this procedure in managing patients with microinvasive cervical adenocarcinoma.
目的：本研究旨在評估子宮頸微浸潤腺癌患者採用保留生育功能治療的安全性。
方法：檢索PubMed，PMC，EMBASE，Web of Science和Cochrane數據庫，收集1949年1月至2018年5月期間發表的相關英語文獻，文章中比較了保留生育與子宮切除術對子宮頸微浸潤腺癌患者預後的影響。對這些文章進行薈萃分析和試驗序貫分析。
結果：共納入8篇文章，包括1256例患者，其中7篇回顧性研究和1項前瞻性研究。只有1名（0.08％）患者有宮旁受累。6名患者（2.2％）手術標本切緣陽性。5名患者（0.4％）淋巴結轉移。總體上，患者的無進展生存率和總生存率分別為99.3％和98.2％。保留生育功能的手術對復發或生存沒有明顯不利影響（P值分別=0.524和0.485）。IA2期較IA1患者更高的比例接受子宮切除術治療（P <0.001）。試驗順序分析表明，累計患者數量未達到所需樣本量（患者數量）。
結論：子宮頸微浸潤腺癌患者的預後良好。保留生育功能治療至少對IA1期的年輕患者是安全的。但是，仍有必要進一步評估該治療方法在管理子宮頸微浸潤腺癌患者中的安全性。
圖1. 保留生育功能和全子宮切除術預後的薈萃分析。a 復發和死亡 (分別是RR: 1.00, 95% CI 0.94–1.06；RR: 1.01, 95% CI 0.98–1.03, respectively). b 無進展生存和總生存 (分別是RR: 1.00, 95% CI 0.94–1.06; RR: 1.01, 95% CI 0.98–1.03)
圖2：保留生育功能和全子宮切除術預後的試驗序貫分析：兩條紅色水平線表示統計量的Z值等於±1.96或p = 0.05。a, 復發; b, DOD; c, RFS; d, OS。沒有Z曲線與紅色水平線相交（Z =±1.96，p = 0.05），累計患者數量未達到所需的信息量（患者數量）。因此因此，需要進一步研究來驗證結論。
補充材料 1：選文流程圖
原文地址：http://sci-hub.ren/10.1007/s00404-018-4799-0
姓 名：奉穎
工作單位：首都醫科大學附屬北京朝陽醫院
職 稱：在讀醫學博士
投稿郵箱：[email protected]
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