Department of Gynecology and Obstetrics, CHUV Lausanne, Lausanne, Switzerland; Faculty of Medicine and Biology, UNIL Lausanne, Lausanne, Switzerland; Department of Gynecology and Obstetrics, HFR Fribourg, Fribourg, Switzerland; Faculty of Medicine, University of Fribourg, 1700 Fribourg, Switzerland.
Breast, Gynecology and Reconstructive Surgery Unit, Institut Curie, Paris, France.
Gynecol Oncol. 2022 Feb;164(2):446-454. doi: 10.1016/j.ygyno.2021.12.015. Epub 2021 Dec 20.
In order to define the clinical significance of low-volume metastasis, a comprehensive meta-analysis of published data and individual data obtained from articles mentioning micrometastases (MIC) and isolated tumor cells (ITC) in cervical cancer was performed, with a follow up of at least 3 years.
We performed a systematic literature review and meta-analysis, following Cochrane's review methods guide and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary outcome was the disease-free survival (DFS), and the secondary outcome was the overall survival (OS). The hazard ratio (HR) was taken as the measure of the association between the low-volume metastases (MIC+ITC and MIC alone) and DFS or OS; it quantified the hazard of an event in the MIC (+/- ITC) group compared to the hazard in node-negative (N0) patients. A random-effect meta-analysis model using the inverse variance method was selected for pooling. Forest plots were used to display the HRs and risk differences within individual trials and overall.
Eleven articles were finally retained for the meta-analysis. In the analysis of DFS in patients with low-volume metastasis (MIC + ITC), the HR was increased to 2.60 (1.55-4.34) in the case of low-volume metastasis vs. N0. The presence of MICs had a negative prognostic impact, with an HR of 4.10 (2.71-6.20) compared to N0. Moreover, this impact was worse than that of MIC pooled with ITCs. Concerning OS, the meta-analysis shows an HR of 5.65 (2.81-11.39) in the case of low-volume metastases vs. N0. The presence of MICs alone had a negative effect, with an HR of 6.94 (2.56-18.81).
In conclusion, the presence of MIC seems to be associated with a negative impact on both the DFS and OS and should be treated as MAC.
为了定义低容量转移的临床意义，对已发表的数据和文章中提到宫颈癌微转移（MIC）和孤立肿瘤细胞（ITC）的个体数据进行了全面的荟萃分析，随访时间至少为 3 年。
我们按照 Cochrane 综述方法指南和系统评价和荟萃分析的首选报告项目（PRISMA）指南进行了系统的文献回顾和荟萃分析。主要结局是无病生存（DFS），次要结局是总生存（OS）。风险比（HR）被视为低容量转移（MIC+ITC 和 MIC 单独）与 DFS 或 OS 之间关联的度量；它量化了 MIC（+/-ITC）组与淋巴结阴性（N0）患者相比的事件风险。选择使用逆方差法的随机效应荟萃分析模型进行汇总。森林图用于显示个体试验和总体中的 HR 和风险差异。
最终有 11 篇文章被纳入荟萃分析。在低容量转移（MIC+ITC）患者的 DFS 分析中，与 N0 相比，低容量转移的 HR 增加到 2.60（1.55-4.34）。MIC 的存在具有负预后影响，与 N0 相比，HR 为 4.10（2.71-6.20）。此外，这种影响比 MIC 与 ITC 合并更差。关于 OS，荟萃分析显示低容量转移与 N0 相比的 HR 为 5.65（2.81-11.39）。MIC 单独存在具有负效应，HR 为 6.94（2.56-18.81）。
总之，MIC 的存在似乎与 DFS 和 OS 的负面影响有关，应视为 MAC。
