Prodromidou Anastasia, Vorgias George, Bakogiannis Konstantinos, Kalinoglou Nikolaos, Iavazzo Christos
Department of Surgical Oncology, Metaxa Memorial Cancer Hospital, Piraeus, Greece; Department of Gynecological Oncology, Metaxa Memorial Cancer Hospital, Piraeus, Greece.
Department of Gynecological Oncology, Metaxa Memorial Cancer Hospital, Piraeus, Greece.
Eur J Obstet Gynecol Reprod Biol. 2018 Nov;230:147-152. doi: 10.1016/j.ejogrb.2018.09.036. Epub 2018 Sep 25.
Microcystic, elongated, fragmented (MELF) pattern of myometrial invasion has been proposed as a prognostic marker in patients with endometrial carcinoma (EC). Its prognostic and predictive effect still remains elusive. The aim of the present study is to accumulate the current knowledge on the role of MELF pattern in the prognosis and survival of patients with EC. Medline, Scopus, Google Scholar, and Clinicaltrials.gov databases were searched for articles published up to May 2018, along with the references of all articles. Prospective and retrospective trials reporting outcomes of cases with EC who were examined for MELF pattern were considered eligible for inclusion in the present systematic review. Of the 196 records screened, 14 were considered eligible. A total of 14 studies which comprised 588 women were finally included in the present systematic review. All the included patients were evaluated for presence of MELF pattern of myometrial invasion. MELF positive (+) patients were more likely to present with larger and higher grade tumors, lymph node metastasis, lymphovascular invasion and >50% myometrial invasion. No difference was reported in disease free survival (DFS) and disease specific survival (DSS) as well as in vaginal recurrence rates. MELF (+) was reported as a significant indicator of survival. In conclusion, MELF pattern of myometrial invasion plays a critical role in lymphovascular space invasion and lymph node metastasis in patients with EC. Regardless, its implication in survival and recurrences is ill determined.
子宫肌层浸润的微囊性、细长形、碎片化（MELF）模式已被提出作为子宫内膜癌（EC）患者的一种预后标志物。其预后和预测作用仍不明确。本研究的目的是积累关于MELF模式在EC患者预后和生存中作用的现有知识。检索了Medline、Scopus、谷歌学术和Clinicaltrials.gov数据库中截至2018年5月发表的文章，以及所有文章的参考文献。报告了对EC病例进行MELF模式检查结果的前瞻性和回顾性试验被认为符合纳入本系统评价的条件。在筛选的196条记录中，14条被认为符合条件。本系统评价最终纳入了14项研究，共588名女性。对所有纳入患者进行子宫肌层浸润MELF模式的评估。MELF阳性（+）患者更有可能出现更大、更高分级的肿瘤、淋巴结转移、淋巴管浸润和>50%的子宫肌层浸润。在无病生存期（DFS）、疾病特异性生存期（DSS）以及阴道复发率方面未报告差异。MELF（+）被报告为生存的一个重要指标。总之，子宫肌层浸润的MELF模式在EC患者的淋巴管间隙浸润和淋巴结转移中起关键作用。尽管如此，其在生存和复发中的意义仍不明确。
