Delli Carpini Giovanni, Cicoli Camilla, Bernardi Marco, Di Giuseppe Jacopo, Giannella Luca, Ciavattini Andrea
Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, 60123 Ancona, Italy.
Cancers (Basel). 2025 May 30;17(11):1839. doi: 10.3390/cancers17111839.
BACKGROUND/OBJECTIVES: The objective of this systematic review and meta-analysis was to compare the risk of recurrence and residual disease between conservative and demolitive treatment in patients diagnosed with cervical adenocarcinoma in situ (AIS).
Bibliographic databases (CENTRAL, PubMed, Cochrane Database of Systematic Reviews, and Google Scholar) were searched for studies published up to December 2024 reporting both conservative and demolitive treatment outcomes. Exclusion criteria were the lack of outcomes of interest, the reporting of only one treatment modality, and a lack of follow-up. The ROBINS-I tool was used to assess the risk of bias. The evaluated outcomes were AIS or invasive recurrence and AIS or invasive residual after margin positivity at the first excision. A meta-analysis with a fixed-effect model and the Mantel-Haenszel method for risk ratio (RR) with a 95% confidence interval (CI) was performed. Heterogeneity was evaluated with the chi-squared test and quantified with the I2 method. A meta-regression was performed using the year of publication, CKC use, margin positivity, and follow-up duration as predictors.
Nineteen studies were included, reporting data about 5934 patients with AIS diagnosis after conization. The meta-analysis showed a higher risk of recurrence as AIS in conservatively treated patients (11 studies, RR = 8.44, 95% CI 3.36-21.19, < 0.001, I2 = 0.0%, = 0.73), while no differences were observed in the risk of recurrence as invasive adenocarcinoma (10 studies, RR = 1.67, 95% CI 0.82-3.39, = 0.16, I2 = 0.00%, = 0.48). No difference between the two treatment modalities in terms of AIS residual (nine studies, RR = 0.89, 95% CI 0.62-1.26, = 0.50, I2 = 33%, = 0.15) or invasive residual (three studies, RR = 0.48, 95% CI 0.09-2.41, = 0.37, I2 = 0.0%, = 0.94) after margin positivity at the first excision emerged. The meta-regression showed no association with the predictors.
The safety profile of a conservative treatment for AIS patients seems not to differ from that of a demolitive approach in terms of invasive recurrence or residual, while it seems to be associated with a higher risk of AIS recurrence. Future research should focus on optimizing follow-up strategies to detect AIS recurrences early.
背景/目的：本系统评价和荟萃分析的目的是比较原位宫颈腺癌（AIS）患者接受保守治疗和根治性治疗后的复发风险和残留疾病情况。
检索文献数据库（CENTRAL、PubMed、Cochrane系统评价数据库和谷歌学术），查找截至2024年12月发表的报告保守治疗和根治性治疗结果的研究。排除标准为缺乏感兴趣的结果、仅报告一种治疗方式以及缺乏随访。使用ROBINS-I工具评估偏倚风险。评估的结果为首次切除切缘阳性后的AIS或浸润性复发以及AIS或浸润性残留。采用固定效应模型和Mantel-Haenszel方法对风险比（RR）进行荟萃分析，并计算95%置信区间（CI）。使用卡方检验评估异质性，并用I2方法进行量化。以发表年份、CKC使用情况、切缘阳性情况和随访时间为预测因素进行荟萃回归分析。
纳入19项研究，报告了5934例锥切术后诊断为AIS患者的数据。荟萃分析显示，保守治疗患者发生AIS复发的风险更高（11项研究，RR = 8.44，95% CI 3.36 - 21.19，P < 0.001，I2 = 0.0%，Q = 0.73），而浸润性腺癌复发风险无差异（10项研究，RR = 1.67，95% CI 0.82 - 3.39，P = 0.16，I2 = 0.00%，Q = 0.48）。两种治疗方式在首次切除切缘阳性后的AIS残留（9项研究，RR = 0.89，95% CI 0.62 - 1.26，P = 0.50，I2 = 33%，Q = 0.15）或浸润性残留（3项研究，RR = 0.48，95% CI 0.09 - 2.41，P = 0.37，I2 = 0.0%，Q = 0.94）方面无差异。荟萃回归分析显示与预测因素无关联。
在浸润性复发或残留方面，AIS患者保守治疗的安全性似乎与根治性治疗无异，但AIS复发风险似乎更高。未来研究应侧重于优化随访策略以早期发现AIS复发。
