Raffone Antonio, Travaglino Antonio, Raimondo Diego, Neola Daniele, Renzulli Federica, Santoro Angela, Insabato Luigi, Casadio Paolo, Zannoni Gian Franco, Zullo Fulvio, Mollo Antonio, Seracchioli Renato
Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy; Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC)., IRCCS Azienda Ospedaliero-Universitaria di Bologna. S. Orsola Hospital. University of Bologna, Via Massarenti 13, Bologna 40138, Italy.
Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy; Gynecopathology and Breast Pathology Unit, Department of Woman's Health Science, Agostino Gemelli University Polyclinic, Rome, Italy.
Gynecol Oncol. 2021 Aug;162(2):401-406. doi: 10.1016/j.ygyno.2021.05.029. Epub 2021 Jun 1.
2021 ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma (EC) encourage molecular classification and propose a new prognostic risk stratification based on both pathologic and molecular features. Although deep myometrial invasion (DMI) has been considered as a crucial risk factor in EC, it is unclear if its prognostic value is independent from The Cancer Genome ATLAS (TCGA) groups.
To assess if the prognostic value of DMI is independent from the TCGA groups in EC patients.
A systematic review and meta-analysis was performed by searching through 5 electronic databases, from their inception to March 2021, for all studies that allowed to assess DMI as a prognostic factor independent of the TCGA groups in EC patients. Pooled hazard ratio (HR) of DMI for overall survival (OS) and disease-free survival (DFS) was calculated at multivariable analyses including TCGA groups as a variable. Superficial myometrial invasion (<50% of myometrial thickness) was considered as a reference. In DFS analyses, locoregional and distant recurrence were separately considered for one study.
Five studies with 2469 patients were included in the systematic review and 3 studies with 1549 patients in the meta-analysis. Pooled HR of DMI was 1.082 (CI 95% 0.85-1.377; p = 0.524) for OS, 1.709 (CI 95% 1.173-2.491; p = 0.005) for DFS, 1.585 (CI 95% 1.154-2.178; p = 0.004) for DFS additionally considering locoregional recurrence for one study, and 1.701 (CI 95% 1.235-2.344, p = 0.001) for DFS additionally considering distant recurrence for the same study.
DMI does not appear as an independent prognostic factor for OS in EC patients; instead, it seems to affect the risk of recurrence independently from the TCGA groups. Further studies are necessary to confirm these findings and to assess the prognostic impact of DMI separately in each TCGA group.
2021年欧洲妇科肿瘤学会（ESGO）/欧洲放射肿瘤学会（ESTRO）/西班牙妇科肿瘤学会（ESP）子宫内膜癌（EC）患者管理指南鼓励进行分子分类，并基于病理和分子特征提出了一种新的预后风险分层。尽管肌层深层浸润（DMI）一直被认为是EC的一个关键危险因素，但其预后价值是否独立于癌症基因组图谱（TCGA）分组尚不清楚。
评估EC患者中DMI的预后价值是否独立于TCGA分组。
通过检索5个电子数据库，从建库至2021年3月，对所有能够评估DMI作为独立于TCGA分组的EC患者预后因素的研究进行系统评价和荟萃分析。在多变量分析中计算DMI对总生存期（OS）和无病生存期（DFS）的合并风险比（HR），将TCGA分组作为一个变量。浅肌层浸润（<肌层厚度的50%）被视为对照。在DFS分析中，一项研究分别考虑了局部和远处复发情况。
系统评价纳入了5项研究共2469例患者，荟萃分析纳入了3项研究共1549例患者。DMI对OS的合并HR为1.082（95%CI 0.85 - 1.377；p = 0.524），对DFS的合并HR为1.709（95%CI 1.173 - 2.491；p = 0.005），一项研究在DFS分析中额外考虑局部复发时DMI的合并HR为1.585（95%CI 1.154 - 2.178；p = 0.004），同一研究在DFS分析中额外考虑远处复发时DMI的合并HR为1.701（95%CI 1.235 - 2.344，p = 0.001）。
在EC患者中，DMI似乎不是OS的独立预后因素；相反，它似乎独立于TCGA分组影响复发风险。需要进一步研究来证实这些发现，并分别评估DMI在每个TCGA分组中的预后影响。
