中国循证医学杂志

中国循证医学杂志

早期卵巢上皮性癌保留生育功能手术有效性的 Meta 分析

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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 PubMed、EMbase、The Cochrane Library(2016 年 8 期)、Web of Science、CBM、WanFang 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 of meta-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) of FSS (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.

关键词: 卵巢上皮性癌; 保留生育功能手术; 根治手术; Meta 分析

Key words: Epithelial ovarian cancer; Fertility sparing surgery; Radical comprehensive surgery; Meta-analysis

引用本文: 刘亚, 秦天强, 陈静, 王红静. 早期卵巢上皮性癌保留生育功能手术有效性的 Meta 分析. 中国循证医学杂志, 2017, 17(4): 409-417. doi: 10.7507/1672-2531.201609105 复制

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