Si Manfei, Jia Lin, Song Kun, Zhang Qing, Kong Beihua
Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, Shandong, P. R. China.
Int J Gynecol Cancer. 2017 Jan;27(1):109-116. doi: 10.1097/IGC.0000000000000842.
Uterine sarcomas are rare, highly aggressive tumors with an unfavorable prognosis. The role of lymphadenectomy (LAD) remains controversial for this particular tumor type. To examine whether LAD can assist in prognosis or clinical benefits for uterine sarcoma patients, we performed a meta-analysis based on published studies.
We initially identified published studies by searching the PubMed database up to 30 November 2015. Study quality was evaluated systematically using the Newcastle-Ottawa Scale for assessing the quality of studies for inclusion in meta-analyses. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated using Stata software version 12.0.
Our search retrieved 14 eligible studies, involving a total of 4867 patients, including 1356 (27.9%) patients who had LAD. The pooled RR for uterine leiomyosarcoma (uLMS) in patients with LAD in 5 trials was 0.90 (95% CI, 0.62-1.31) and for endometrial stromal sarcoma (ESS) in 11 trials was 0.96 (95% CI, 0.69-1.34), suggesting that there was no significant benefit of LAD in improving overall survival (P < 0.05). A random-effects model was chosen to estimate the RRs in view of the significant heterogeneity in the included studies (uLMS: Cochran Q test: P = 0.022, I = 64.9%; ESS: Cochran Q test: P = 0.005, I = 60.1%). No publication bias was detected by the Egger and Begg tests (uLMS: Begg: P = 0.221, Egger: P = 0.148; ESS: Begg: P = 1.000, Egger: P = 0.928).
Based on currently available evidence, the findings of this meta-analysis suggest that LAD bears little prognostic or therapeutic benefit in patients with uterine sarcoma. Systematic LAD may not be recommended in patients with uLMS or ESS unless the patient has obvious extrauterine involvement, clinically suspicious enlarged nodes, or advanced sarcomas.
子宫肉瘤是罕见的、侵袭性很强的肿瘤，预后不良。对于这种特定类型的肿瘤，淋巴结切除术（LAD）的作用仍存在争议。为了研究LAD是否有助于子宫肉瘤患者的预后或临床获益，我们基于已发表的研究进行了一项荟萃分析。
我们最初通过检索截至2015年11月30日的PubMed数据库来确定已发表的研究。使用纽卡斯尔-渥太华量表系统地评估研究质量，以评估纳入荟萃分析的研究质量。使用Stata软件12.0版计算合并相对风险（RRs）和95%置信区间（CIs）。
我们的检索共获得14项符合条件的研究，涉及总共4867例患者，其中1356例（27.9%）患者接受了LAD。5项试验中接受LAD的子宫平滑肌肉瘤（uLMS）患者的合并RR为0.90（95%CI，0.62-1.31），11项试验中子宫内膜间质肉瘤（ESS）患者的合并RR为0.96（95%CI，0.69-1.34），这表明LAD在改善总生存期方面没有显著益处（P<0.05）。鉴于纳入研究中存在显著异质性（uLMS： Cochr an Q检验：P = 0.022，I = 64.9%；ESS： Cochr an Q检验：P = 0.005，I = 60.1%），因此选择随机效应模型来估计RRs。通过Egger和Begg检验未检测到发表偏倚（uLMS：Begg：P = 0.221，Egger：P = 0.148；ESS：Begg：P = 1.000，Egger：P = 0.928）。
基于目前可得的证据，这项荟萃分析的结果表明LAD对子宫肉瘤患者几乎没有预后或治疗益处。除非患者有明显的子宫外受累、临床上可疑的淋巴结肿大或晚期肉瘤，否则不建议对uLMS或ESS患者进行系统性LAD。
