子宫内膜癌患者肿瘤直径与淋巴结转移及复发的相关性：一项系统评价和荟萃分析。
The association of tumor diameter with lymph node metastasis and recurrence in patients with endometrial cancer: a systematic review and meta-analysis.
作者信息
Fu Ruifang, Zhang Dongli, Yu Xiaohan, Zhang Hongxia
机构信息
Department of Gynecology, Huaihe Hospital of Henan University, Kaifeng, China.
出版信息
Transl Cancer Res. 2022 Nov;11(11):4159-4177. doi: 10.21037/tcr-22-2595.
BACKGROUND
Tumor diameter (TD)/original lesion area has been reported to have a certain predictive effect on lymph node metastasis (LNM) and recurrence of endometrial cancer (EC) patients, but there is still controversy about their relationship. Therefore, we conducted a meta-analysis to provide reference for clinical management and follow-up studies of patients with EC.
METHODS
The databases of PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP, and Wanfang were searched, from inception to 27 October 2022, for studies regarding the association of TD with LNM risk and recurrence rate in EC. The search strategy was developed using a combination of free terms and medical subject headings (MeSH). Stata 15.0 was used to conduct the statistical analysis. Odds ratio (OR) with the 95% confidence interval (CI) were calculated to evaluate the association of TD and the risk of LNM and recurrence in EC patients. The OR value obtained from the multivariate analysis is first extracted; the results of univariate analysis were extracted for articles without the results of multivariate analysis. Newcastle-Ottawa Scale (NOS) assessed the quality of the included articles, publication bias was evaluated by Egger's test with funnel plots.
RESULTS
There was a total of 69 studies 123,383 EC patients included. Meta-analysis showed higher LNM risk in EC patients with the TD >2 cm, which was 2.88 times higher than that in those with ≤2 cm, and the difference was statistically significant (OR =2.88; 95% CI: 2.12-3.89; P<0.001), publication bias had no effect on the results. The risk of recurrence in EC patients with a TD >2 cm was 2.45 times higher than that in those with ≤2 cm (OR =2.45; 95% CI: 1.73-3.48; P<0.001), publication bias exerted influence over the results.
CONCLUSIONS
TD is associated with LNM and recurrence in patients with EC. Therefore, TD should be considered in the scope of surgery and adjuvant therapy.
背景
据报道，肿瘤直径（TD）/原发病灶面积对子宫内膜癌（EC）患者的淋巴结转移（LNM）和复发具有一定的预测作用，但它们之间的关系仍存在争议。因此，我们进行了一项荟萃分析，为EC患者的临床管理和随访研究提供参考。
方法
检索了PubMed、Embase、Web of Science、Cochrane图书馆、中国知网（CNKI）、维普（VIP）和万方数据库，检索时间从建库至2022年10月27日，以查找关于TD与EC患者LNM风险和复发率相关性的研究。检索策略采用自由词和医学主题词（MeSH）相结合的方式制定。使用Stata 15.0进行统计分析。计算比值比（OR）及其95%置信区间（CI），以评估TD与EC患者LNM风险和复发的相关性。首先提取多变量分析获得的OR值；对于没有多变量分析结果的文章，提取单变量分析的结果。采用纽卡斯尔-渥太华量表（NOS）评估纳入文章的质量，通过Egger检验结合漏斗图评估发表偏倚。
结果
共纳入69项研究，涉及123383例EC患者。荟萃分析显示，TD>2 cm的EC患者发生LNM的风险更高，是TD≤2 cm患者的2.88倍，差异有统计学意义（OR =2.88；95%CI：2.12-3.89；P<0.001），发表偏倚对结果无影响。TD>2 cm的EC患者复发风险是TD≤2 cm患者的2.45倍（OR =2.45；95%CI：1.73-3.48；P<0.001），发表偏倚对结果有影响。
结论
TD与EC患者的LNM和复发相关。因此，在手术和辅助治疗范围内应考虑TD。
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