早期卵巢上皮性癌保留生育功能手术有效性的Meta分析

The efficiency of fertility-sparing surgery in early stage epithelial ovarian cancer:a meta-analysis

目的系统评价保留生育功能手术与根治性手术相比治疗早期卵巢上皮性癌的有效性。方法计算机检索Pub Med、EMbase、The Cochrane Library(2016年8期)、Web of Science、CBM、Wan Fang Data和CNKI数据库,搜集有关保留生育功能手术与根治性手术治疗早期卵巢上皮性癌的相关研究,检索时限均为建库至2016年8月10日。由2位研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用Stata 12.0软件进行Meta分析。结果共纳入8个研究,包括2 561例患者。Meta分析结果显示:与根治性手术相比,保留生育功能手术治疗早期卵巢上皮性癌后患者的总体生存率[单变量分析:RR=1.03,95%CI(0.98,1.07);多变量分析:RR=0.81,95%CI(0.52,1.28)]、无病生存率[单变量分析:RR=1.02,95%CI(0.96,1.09);多变量分析:RR=1.24,95%CI(0.65,2.39)]和术后疾病复发率[RR=0.86,95%CI(0.57,1.30)]方面,差异无统计学意义;同时与根治性手术相比,保留生育功能手术后IA期患者总体生存率[RR=0.99,95%CI(0.98,1.02)]、无病生存率[RR=1.01,95%CI(0.95,1.06)]和IC期患者总体生存率[RR=0.95,95%CI(0.86,1.04)]、无病生存率[RR=0.94,95%CI(0.80,1.11)]方面,差异无统计学意义。结论保留生育功能手术治疗早期卵巢上皮性癌不会明显增加其复发率或降低生存率,手术方式不是影响患者预后的主要因素。受纳入研究的数量和质量的限制,上述结论尚需要更多研究予以证实。

Objective To systematically evaluate the efficiency of fertility-sparing surgery （FSS） compared with radical comprehensive surgery （RCS） in early stage epithelial ovarian cancer （eEOC）. Methods We searched databases including PubMed, EMbase, The Cochrane Library （Issue 8, 2016）, Web of Knowledge, CBM, WanFang Data and CNKI to collect the studies about FSS compared with RCS for eEOC from ineaption to August 10th, 2016. Two reviewers independently evaluated the eligibility of identified studies and extracted the data. Then, meta-analysis was performed using Stata 12.0 software. Results Eight studies involving 2 561 patients were included. The results ofmeta-analysis showed that： compared with RCS, the aggregated RR of overall survival （OS） of FSS （univariate analysis： RR=1.03, 95%CI 0.98 to 1.07, P=0.815; multivariate analysis： RR=0.81, 95%CI 0.52 to 1.28, P=0.255）, the cumulative disease free survival （DFS） ofFSS （univariate analysis： RR=1.02, 95%CI 0.96 to 1.09, P=0.968; multivariate analysis： RR=1.24, 95%CI 0.65 to 2.39, P=0.115） and the recurrence of FSS （RR=0.86, 95%CI 0.57 to 1.30, P=0.902）, there was no significant difference. This pattern also emerged in the subgroup analysis for FIGO IA and IC patients, and the results showed that there was no significant difference between FSS and RCS in IA patients （OS： RR=0.99, 95%CI 0.98 to 1.02, P=0.186; DFS： RR=1.01, 95%CI 0.95 to 1.06, P=0.541）; and IC patients （OS： RR=0.95, 95%CI 0.86 to 1.04, P=0.251; DFS： RR=0.94, 95%CI 0.80 to 1.11, P=0.664）. Conclusion In eEOC, FSS does not have a negative effect on oncological outcomes compared with RCS. However, well-designed and large-scale trials are needed to verify this outcome in the future.