Abu-Zaid Ahmed, Alomar Osama, Abuzaid Mohammed, Baradwan Saeed, Salem Hany, Al-Badawi Ismail A
College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Obstetrics and Gynecology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
Department of Obstetrics and Gynecology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Eur J Obstet Gynecol Reprod Biol. 2021 Mar;258:382-390. doi: 10.1016/j.ejogrb.2021.01.038. Epub 2021 Jan 27.
To systematically and meta-analytically pool the existing evidence regarding the prognostic impact of preoperative anemia (hemoglobin level <12 mg/dl) in patients with endometrial cancer.
Four (PubMed, Embase, Scopus and Web of Science) databases were searched from inception to 20-August-2020. We assessed the risk of bias using the Newcastle-Ottawa Scale. We estimated the pooled prevalence of preoperative anemia in the included studies. We pooled odds ratios (ORs) and hazard ratios (HRs) with their 95 % confidence intervals (95 % CIs) to evaluate the correlation between preoperative anemia and its impact on clinicopathologic parameters and survival outcomes. Analyses were performed under random- or fixed-effects meta-analysis models depending on data heterogeneity.
Seven studies met the inclusion criteria comprising 1495 patients with endometrial cancer. Nearly all studies had low risk of bias. The pooled prevalence of preoperative anemia was 26.5 % (95 % CI: 18.6%-36.2%). Preoperative anemia significantly correlated with advanced FIGO stage III-IV (OR = 5.14, 95 % CI [3.36, 7.86], p < 0.00001), ≥50 % myometrial invasion (OR = 1.95, 95 % CI [1.36, 2.78], p = 0.0003), lymph node metastasis (OR = 4.46, 95 % CI [2.39, 8.30], p < 0.00001), non-endometrioid histology (OR = 3.25, 95 % CI [1.89, 5.60], p < 0.0001), adnexal involvement (OR = 5.88, 95 % CI [3.05, 10.23], p < 0.001), cervical involvement (OR = 2.91, 95 % CI [1.65, 5.11], p = 0.0002), positive peritoneal cytology (OR = 3.24, 95 % CI [1.41, 7.44], p = 0.006), preoperative thrombocytosis (OR = 6.66, 95 % CI [3.05, 14.52], p < 0.00001) and lymphovascular space invasion (OR = 3.50, 95 % CI [1.82, 6.74], p = 0.0002). High tumor grade II-III was increased in patients with preoperative anemia, yet this effect was not statistically significant (OR = 2.12, 95 % CI [0.97, 4.66], p = 0.06). Consistently, the five-year overall survival (OS) and disease-free survival (DFS) rates were significantly lower in patients with preoperative anemia when compared to those without preoperative anemia. Pooled HR showed that preoperative anemia was significantly associated with reduced DFS at univariate (HR = 3.22, 95 % CI [1.28, 8.11], p = 0.01) and multivariate (HR = 1.02, 95 % CI [1.00, 1.05], p = 0.03) analyses.
Preoperative anemia predicts poor clinicopathologic and survival outcomes in patients with endometrial cancer.
系统地进行荟萃分析，汇总关于术前贫血（血红蛋白水平<12mg/dl）对子宫内膜癌患者预后影响的现有证据。
检索了四个数据库（PubMed、Embase、Scopus和Web of Science）自建库至2020年8月20日的数据。我们使用纽卡斯尔-渥太华量表评估偏倚风险。我们估计了纳入研究中术前贫血的合并患病率。我们汇总了比值比（OR）和风险比（HR）及其95%置信区间（95%CI），以评估术前贫血与其对临床病理参数和生存结局影响之间的相关性。根据数据异质性，在随机或固定效应荟萃分析模型下进行分析。
七项研究符合纳入标准，共纳入1495例子宫内膜癌患者。几乎所有研究的偏倚风险都较低。术前贫血的合并患病率为26.5%（95%CI：18.6%-36.2%）。术前贫血与晚期国际妇产科联盟（FIGO）III-IV期显著相关（OR = 5.14，95%CI [3.36, 7.86]，p < 0.00001）、肌层浸润≥50%（OR = 1.95，95%CI [1.36, 2.78]，p = 0.0003）、淋巴结转移（OR = 4.46，95%CI [2.39, 8.30]，p < 0.00001）、非子宫内膜样组织学（OR = 3.25，95%CI [1.89, 5.60]，p < 0.0001）、附件受累（OR = 5.88，95%CI [3.05, 10.23]，p < 0.001）、宫颈受累（OR = 2.91，95%CI [1.65, 5.11]，p = 0.0002）、阳性腹膜细胞学（OR = 3.24，95%CI [1.41, 7.44]，p = 0.006）、术前血小板增多症（OR = 6.66，95%CI [3.05, 14.
