子宫内膜癌微囊延长和破碎模式的临床病理及预后意义：一项系统评价和荟萃分析
Clinicopathological and prognostic significance of the microcystic elongated and fragmented pattern in endometrial cancer: a systematic review and meta-analysis.
作者信息
Jia Peng, Duan Baofeng, Zhang Yan
机构信息
Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China.
Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
出版信息
BMJ Open. 2025 Jan 28;15(1):e092006. doi: 10.1136/bmjopen-2024-092006.
OBJECTIVE
The presence of the microcystic elongated and fragmented (MELF) pattern, distinguished by its microcystic, elongated and fragmented attributes, constitutes a common manifestation of myometrial invasion (MI) within endometrial carcinoma. However, the prognostic significance of this pattern has not been definitively established. Consequently, this research aimed to clarify the prognostic implications of the MELF pattern for individuals diagnosed with endometrial carcinoma.
DESIGN
Systematic review and meta-analysis of observational clinical studies.
DATA SOURCES
An extensive review of the literature was conducted using reputable databases such as PubMed, Embase, Web of Science and the Cochrane Library, covering the period from January 2003 to October 2023. Search terms encompassed endometrial cancer and the MELF pattern.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
The inclusion criteria were patients who had undergone hysterectomy and whose pathology confirmed endometrial endometrioid carcinoma, with or without MELF infiltration.
DATA EXTRACTION AND SYNTHESIS
Two reviewers performed data extraction separately. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). Stata V.17.0 software was used for statistical analysis.
RESULTS
The meta-analysis incorporated 16 retrospective cohort studies. Employing a fixed-effects approach, the analysis demonstrated an association of the MELF pattern with reduced overall survival (HR 2.21, 95% CI 1.50-3.25, p=0.000) and lower disease-free survival rates among patients with endometrial cancer (HR 1.72, 95% CI 1.17 to 2.55, p=0.006). Furthermore, aggregated data revealed a linkage between the MELF pattern and significant MI, nodal metastasis, involvement of the lymphovascular space, penetration of the cervical stroma and progression to advanced stages of endometrial carcinoma.
CONCLUSION
The MELF pattern serves as a significant adverse prognostic factor in endometrial cancer, warranting increased attention.
目的
微囊状拉长破碎（MELF）模式以其微囊状、拉长和破碎的特征为特点，是子宫内膜癌肌层浸润（MI）的常见表现。然而，这种模式的预后意义尚未明确确立。因此，本研究旨在阐明MELF模式对子宫内膜癌患者的预后影响。
设计
对观察性临床研究进行系统评价和荟萃分析。
数据来源
使用如PubMed、Embase、Web of Science和Cochrane图书馆等知名数据库对文献进行广泛检索，涵盖2003年1月至2023年10月期间。检索词包括子宫内膜癌和MELF模式。
研究选择的纳入标准
纳入标准为接受子宫切除术且病理证实为子宫内膜样腺癌、有或无MELF浸润的患者。
数据提取与合成
两名研究者分别进行数据提取。使用纽卡斯尔-渥太华量表（NOS）评估纳入研究的质量。采用Stata V.17.0软件进行统计分析。
结果
荟萃分析纳入了16项回顾性队列研究。采用固定效应模型分析表明，MELF模式与子宫内膜癌患者总体生存率降低（风险比2.21，95%置信区间1.50 - 3.25，p = 0.000）及无病生存率降低相关（风险比1.72，95%置信区间1.17至2.55，p = 0.006）。此外，汇总数据显示MELF模式与显著的肌层浸润、淋巴结转移、脉管间隙受累、宫颈间质浸润以及子宫内膜癌进展至晚期之间存在关联。
结论
MELF模式是子宫内膜癌的一个重要不良预后因素，值得更多关注。
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