620例子宫内膜间质肉瘤临床特征的系统评价

Systematic review of clinical features in 620 cases with endometrial stromal sarcoma

目的探讨子宫内膜间质肉瘤(endometrial stromal sarcoma,ESS)的临床特征、治疗及预后情况。方法计算机检索CBM、万方、维普及CNKI数据库,检索年限均从建库到2011年1月。按Cochrane系统评价方法筛选研究、评价纳入研究的方法学质量、提取资料、分析数据。结果 20篇文献符合纳入标准,其中包括620例子宫内膜间质肉瘤患者。Meta分析汇总结果表明,ESS患者以低度恶性子宫内膜间质肉瘤居多,中位年龄为45岁;主要临床症状包括月经不规律、腹痛、腹部或盆腔包块、宫颈赘生物或阴道脱出物等;临床治疗主要以手术为基础的综合治疗,其中以手术联合化疗居多;ESS患者3年和5年中位生存率分别为71.4%和68.8%,而中位复发率则高达37.0%。结论 ESS是临床较少见的女性生殖系统肿瘤,临床症状无特殊性,治疗方式主要以手术为基础的综合治疗,5年中位生存率为68.8%,中位复发率达37.0%。由于本系统评价纳入研究方法学质量不均,各研究间病例数、评价方法、数据描述等方面存在的差异,以上结论尚需更多大样本临床研究加以证实。

【Objective】 To investigate the clinical features,treatment and prognosis of endometrial stromal sarcoma（ESS） patients.【Methods】 Based on the principles and methods of Cochrane systematic reviews,CBM,VIP,WANFANG and CNKI databases from inception to Jan 2011 were searched.Included studies according to the Cochrane Handbook for systematic reviews were evaluated.【Results】 Twenty trials with a total of 620 ESS patients were included.Meta-analysis results showed that： low-grade endometrial stromal sarcoma was the main pathological type,the median age was 45 year-old.The main clinical symptoms included irregular menstruation,abdominal pain,abdominal or pelvic mass,cervical or vaginal prolapsed materials,et al.The main clinical treatment method was surgery-based comprehensive treatment,and surgery combined with chemotherapy was the most common.The median 3-and 5-year survival ratio in ESS patients were 71.4% and 68.8%,but The median recurrence ratio was high as 37.0%.【Conclusion】 ESS is a rare female reproductive tumor without specific clinical symptoms,the main clinical treatment method is surgery-based comprehensive treatment,and the median 5-year survival ratio and recurrence ratio are 68.8% and 37.0%.As many limitations in current study,it should be emphasized the necessity to conduct large studies with an adequate methodological quality,properly controlling for possible confounds in order to obtain valid results.