Oncologic and obstetrical outcomes with fertility-sparing treatment of cervical cancer: a systematic review and meta-analysis.
Oncologic and obstetrical outcomes with fertility-sparing treatment of cervical cancer: a systematic review and meta-analysis.
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保留生育能力的宫颈癌治疗的肿瘤学和产科结果：系统评价和荟萃分析
DOI：
10.18632/oncotarget.16233
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发表时间：
2017-07-11
期刊：
影响因子：
--
通讯作者：
Kong B
中科院分区：
文献类型：
--
作者：
Zhang Q;Li W;Kanis MJ;Qi G;Li M;Yang X;Kong B
目的评价宫颈锥切术(CON)、根治性沙眼切除术(RT)加或不加盆腔淋巴清扫术治疗早期宫颈癌(ECC)的复发率、生存率、妊娠率及妊娠结局。研究设计这是一项对观察性研究的荟萃分析，通过随机效应模型和Meta回归分析来评估异质性。结果纳入60项观察性研究，涉及2854名患者；其中17项评估CON，43项评估RT。CON组375例：IA1期176例(46.9%)，IB1期167例(44.5%)。RT组2479例，其中IA1期143例(6.0%)，IA2期299例(12.1%)，1987年IB1期(79.9%)。CON组347例(92.5%)，复发率0.4%(95%CI：0.0%~1.4%)，病死率0%(0%~0%)，妊娠率36.1%(26.4%~46.2%)，自然流产率14.8%(9.3%~21.2%)，早产率6.8%(1.5%~15.5%)。RT组2273例(91.7%)手术成功，复发率2.3%(1.3%~3.4%)，死亡率0.7%(0.3%~1.1%)，妊娠率20.5%(16.8%~24.5%)，自然流产率24.0%(18.8%~29.6%)，早产率26.6%(19.6%~34.2%)。亚组分析显示，接受CON和RT治疗的IA期肿瘤的复发率分别为0.4%(0.0%~1.9%)和0.7%(0.0%~2.3%)，IB期肿瘤的复发率分别为0.6%(0.0%~2.7%)和2.3%(0.9%~4.1%)。结论包括CON或RT在内的保留生育治疗ECC是可行的，精心选择的妇女可以保留生育能力并获得妊娠，从而获得活产。在复发率和死亡率相似的情况下，CON的妊娠结局似乎比RT更好。
OBJECTIVE The objectives of this study were to evaluate the rates of recurrence, survival and pregnancy, and characterize pregnancy outcomes of early-stage cervical cancer(eCC) treated with fertility-sparing methods such as cervical conization (CON) and radical trachelectomy(RT) with or without pelvic lymphadenectomy. STUDY DESIGN This was a meta-analysis of observational studies analyzed by a random-effects model and a meta-regression to assess heterogeneity. RESULTS Sixty observational studies encompassing 2,854 patients were included; 17 of which evaluated CON and 43 RT. Three hundred and seventy-five patients were included in the CON group: 176(46.9%) stage IA1 and 167(44.5%) stage IB1. In the RT group, 2479 cases were included: 143(6.0%) stage IA1, 299(12.1%) stage IA2, 1987(79.9%) stage IB1. CON was performed in 347(92.5%) cases, resulting in a recurrence rate of 0.4%(95%CI: 0.0%-1.4%), a death rate of 0%(0%-0%), a pregnancy rate of 36.1%(26.4%-46.2%), a spontaneous abortion rate of 14.8%(9.3%-21.2%) and a preterm delivery rate of 6.8%(1.5%-15.5%). For the RT group, 2273(91.7%) underwent successful surgeries with a recurrence rate of 2.3%(1.3%-3.4%),a death rate of 0.7%(0.3%-1.1%), a pregnancy rate of 20.5%(16.8%-24.5%), a spontaneous abortion rate of 24.0%(18.8%-29.6%) and a preterm delivery rate of 26.6%(19.6%-34.2%). From a subgroup analysis, the recurrence rates for stage IA tumors treated with CON and RT were 0.4%(0.0%-1.9%) and 0.7%(0.0%-2.3%), respectively; and for stage IB were 0.6%(0.0%-2.7%) and 2.3%(0.9%-4.1%). CONCLUSION Fertility-sparing treatment including CON or RT for eCC is feasible and carefully selected women can preserve fertility and achieve pregnancy resulting in live births. CON seems to result in better pregnancy outcomes than RT with similar rates of recurrence and mortality.
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DOI：
10.1111/igc.0b013e3181b9549a
发表时间：
2009-11-01
影响因子：
4.8
作者：
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DOI：
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发表时间：
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期刊：
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society
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2011-12-01
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DOI：
10.1111/igc.0b013e3181a1a297
发表时间：
2009-04-01
影响因子：
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