术后辅助化疗在早期子宫平滑肌肉瘤治疗中的作用Meta分析

The role of postoperative adjuvant chemotherapy in the treatment of early uterine leiomyosarcoma:a meta-analysis

目的应用Meta分析的方法评价辅助化疗治疗早期子宫平滑肌肉瘤(uterine leiomyosarcoma,uLMS)的临床效果。方法检索PubMed、Embase、Cochrane图书馆、中国知网(CNKI)、中国生物医学文献数据光盘数据库(CBM disc)及维普数据库(VIP)中对比单纯手术和术后辅助化疗的对照研究。检索时间从建库至2021年6月。根据纽卡斯尔-渥太华量表(the Newcastle-Ottawa Scale,NOS)量表评价文献质量并提取资料。采用Rev Man 5.3进行异质性检验及Meta分析。结果检出相关文献1054篇,根据纳入排除标准最终入选7篇文献,入选病例共计437例,其中辅助化疗组(adjuvant chemotherapy,AC)188例,单纯手术组(isolated operation,IO)249例。IO组与AC组在术后总复发率(OR=0.90;95%CI:0.60~1.34)、随访期死亡率(OR=1.46;95%CI:0.07~31.72)上差异无统计学意义(分别P=0.60,P=0.81)。与单纯手术组相比,AC组均未降低术后局部复发(OR=0.93;95%CI:0.56~1.54)、远处复发(OR=1.27;95%CI:0.76~2.13)和局部+远处复发(OR=0.89;95%CI:0.25~3.21)的发生率(分别P=0.77、0.35和0.85)。两组患者在术后无病生存率(OR=2.55;95%CI:0.98~6.67)上差异无统计学意义(P=0.06)。亚组分析结果表明,纳入Ⅰ期患者的研究中和纳入Ⅰ、Ⅱ期患者的研究中AC组和IO组总复发率、局部复发和远处复发的差异均无统计学意义。结论术后AC可能与早期uLMS手术患者复发率和死亡率无关联,因此AC的在这种情况下的作用尚不清楚,需要进一步的观察和随访。

Objective The purpose of this study is to evaluate the clinical effect of adjuvant chemotherapy(AC)in the treatment of early uterine leiomyosarcoma(uLMS).Method PubMed,Embase,the Cochrane Controlled Trials Register databases,CNKI,CBM disc and VIP database were searched for the studies which compare the effect of isolated operation(IO)and postoperative adjuvant chemotherapy(AC).Literature searches from database establishment to June 2021.The risk of bias was evaluated by using Newcastle Ottawa scale(NOS)and the data were extracted.The heterogeneity and data were analyzed by the software of Rev Man 5.3.Result A total of 1054 studies were screened.7 studies met eligibility criteria and finally enrolled.Among 437 patients,188 cases were in the AC group and 249 cases were in the IO group.Compared between AC vs IO,the pooled OR of total recurrence incidence was 0.90(95%CI:0.60-1.34)and pooled OR of total mortality was 1.46(95%CI:0.07-31.72).Compared between AC vs IO,local recurrence(pooled OR=0.93;95%CI:0.56-1.54;P=0.77),distant recurrence(pooled OR=1.27;95%CI:0.76-2.13;P=0.35),local+distant recurrence(pooled OR=0.89;95%CI:0.25-3.21;P=0.85)and disease-free survival rate(pooled OR=2.55;95%CI:0.98-6.67;P=0.06)did not show significance.Subgroup analysis showed that pooled OR for total recurrence rate,local recurrence and distant recurrence did not show significance in patients with stageⅠandⅡ.Conclusion Postoperative AC may be not associated with the recurrence rate and mortality in early uLMS patients.Therefore,the role of AC is unclear and needs further observation and follow-up.