嗜神经侵袭与早期宫颈癌预后相关性的Meta分析

The prognostic significance of perineural invasion in early-stage cervical cancer:a meta-analysis

目的系统评价嗜神经侵袭(PNI)对早期宫颈癌患者预后的影响。方法计算机检索PubMed、EMbase、The Cochrane Library(2016年10期)、CNKI、WanFang Data、CBM、VIP数据库,搜集PNI与早期宫颈癌预后相关性的病例-对照研究,检索时间截止至2016年10月。由两名评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险评价后,采用Rev Man 5.3软件进行统计分析。结果最终纳入8篇文献,共7个病例-对照研究,1 218例患者。Meta分析结果显示:(1)Cox比例风险模型进行多因素生存分析,PNI不是影响无瘤生存率(DFS)[HR=0.73,95%CI(0.33,1.58),P=0.42]和总生存率(OS)[HR=0.89,95%CI(0.41,1.94),P=0.77]的独立因素;(2)Kaplan-Meier生存曲线分析,PNI阳性组的总体DFS[HR=1.86,95%CI(1.20,2.88),P=0.006]和OS[HR=2.43,95%CI(1.63,3.62),P<0.000 1]明显低于PNI阴性组,差异有统计学意义。结论目前还没有证据表明宫颈癌PNI是影响预后的独立因素,但是作为影响宫颈癌DFS和OS的不良因素之一,可考虑成为制定术后辅助治疗方案的一个指标。鉴于纳入研究的局限性,上述结论还需要大样本前瞻性对照研究来进一步验证。

Objective To systematically review the prognostic value of perineural invasion （PNI） for patients with early-stage cervical cancer. Methods We searched PubMed, EMbase, The Cochrane Library （Issue 10, 2016）, CNKI, WanFang Data, CBM and VIP databases to collect case-control studies about prognostic value of PNI in cervical cancer from inception to October, 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using RevMan 5.3 software. Results Seven case-control studies from eight articles involving 1 218 patients were included. The results of meta-analysis showed that： （1） On Cox＇s model multivariate analysis, PNI was not identified as an independent risk factor for disease free survival （DFS） （HR=0.73, 95%CI 0.33 to 1.58, P=0.42） or overall survival （OS） （HR=0.89, 95%CI 0.41 to 1.94, P=0.77） with no significant difference; （2） On Kaplan-Meier-curves, DFS （HR=1.86, 95%CI 1.20 to 2.88, P=0.006） and OS （HR=2.43, 95%CI 1.63 to 3.62, P〈0.000 1） were both significantly decreased in patients with PNI positive group. Conclusion PNI represents a decreasing disease- free survival and overall survival in patients with early-stage cervical cancer, and is one of the poor prognosis factors which be informed management decisions regarding adjuvant therapy. However, there is no evidence that PNI is an independent factor affecting the prognosis. In view of the limitation of the studies, a large sample prospective controlled trial is warranted to verify the above conclusion.