Wang Jian Zhang, Xiong Yu Jing, Man Gene Chi Wai, Chen Xiao Yan, Kwong Joseph, Wang Chi Chiu
Department of Obstetrics and Gynaecology, Block E, 1/F, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong.
Arch Gynecol Obstet. 2018 Mar;297(3):731-740. doi: 10.1007/s00404-018-4648-1. Epub 2018 Jan 11.
The study aimed to systematically review the association between angiogenesis and clinicopathological characteristics and its prognostic value in patients with endometrial cancer.
Eligible studies were searched in PubMed, Embase, China National Knowledge Infrastructure, and Wanfang database. Studies that assessed blood microvessel density (BMVD) and correlated with clinicopathological features and/or overall survival (OS) were included. Geometric mean values and hazard ratio with 95% confidence interval were pooled to examine the risk or hazard association. Subgroup analyses were conducted based on populations, BMVD criteria, BMVD markers, and type of survival analysis.
A total of 29 studies of 2517 patients were included. BMVD was associated with depth of myometrial invasion (MI) [standard mean difference (SMD) 1.24; 95% CI 0.53-1.95; P = 0.0006], lymphovascular space invasion (LVSI) (SMD 0.75; 95% CI 0.3-1.21; P = 0.001), and lymph node metastasis (LNM) (SMD 0.99; 95% CI 0.46-1.52; P = 0.0003). BMVD was also significantly associated with poor OS (HR 2.65; 95% CI 1.86-3.77; P < 0.00001). The association remained significant in the subgroups Asian population, BMVD criteria using Weidner method, BMVD marker CD34 for MI, LVSI, and LNM, CD105 for MI, and factor VIII for MI and LNM, respectively. For OS, either Asian or non-Asian population, BMVD criteria using Weidner or non-Weidner method, BMVD marker CD31, or factor VIII antibody and analysis using univariate or multivariate were all significantly associated.
BMVD was associated with deeper MI, positive LVSI, positive LNM, and poor OS in patients with endometrial cancer. Therefore, angiogenesis is a useful measure for poor clinicopathological outcomes and prognosis in patients with endometrial cancer.
本研究旨在系统评价子宫内膜癌患者血管生成与临床病理特征之间的关联及其预后价值。
在PubMed、Embase、中国知网和万方数据库中检索符合条件的研究。纳入评估血液微血管密度（BMVD）并与临床病理特征和/或总生存期（OS）相关的研究。汇总几何平均值和95%置信区间的风险比，以检验风险或危害关联。根据人群、BMVD标准、BMVD标志物和生存分析类型进行亚组分析。
共纳入29项研究，涉及2517例患者。BMVD与肌层浸润深度（MI）相关[标准平均差（SMD）1.24；95%置信区间0.53 - 1.95；P = 0.0006]，与淋巴血管间隙浸润（LVSI）相关（SMD 0.75；95%置信区间0.3 - 1.21；P = 0.001），与淋巴结转移（LNM）相关（SMD 0.99；95%置信区间0.46 - 1.52；P = 0.0003）。BMVD还与较差的OS显著相关（HR 2.65；95%置信区间1.86 - 3.77；P < 0.00001）。在亚洲人群亚组、使用Weidner方法的BMVD标准、用于MI、LVSI和LNM的BMVD标志物CD34、用于MI的CD105以及分别用于MI和LNM的因子VIII亚组中，该关联仍然显著。对于OS，无论是亚洲人群还是非亚洲人群，使用Weidner或非Weidner方法的BMVD标准、BMVD标志物CD31或因子VIII抗体以及单变量或多变量分析均显著相关。
BMVD与子宫内膜癌患者更深的MI、阳性LVSI、阳性LNM和较差的OS相关。因此，血管生成是子宫内膜癌患者临床病理结局和预后不良的一个有用指标。
