Zhou Li, Li Chengyao, Zhao Jianguo, Li Pu, Qu Pengpeng
Clinical School of Obstetrics and Gynecology Center, Tianjin Medical University, Tianjin, China.
Department of General Gynecology, Tianjin Central Hospital of Obstetrics and Gynecology, Tianjin, China.
Front Oncol. 2025 Jun 25;15:1527324. doi: 10.3389/fonc.2025.1527324. eCollection 2025.
The prognostic significance of the microcystic, elongated, and fragmented (MELF) invasion pattern in endometrial carcinoma (EC) has not been fully elucidated. This study conducted a systematic search across five electronic databases (PubMed, EMBASE, Cochrane, Web of Science, and the Chinese National Knowledge Infrastructure (CNKI)) from inception to April 2025. Assessment focused on overall survival (OS), disease-free survival (DFS), lymph node metastasis (LNM), and recurrence rate (RR) as primary outcomes. Meta-analysis calculations of overall odds ratios (ORs) and hazard ratios (HRs) with corresponding 95% confidence intervals (CIs) elucidated the impact of the MELF pattern on clinical outcomes. Analysis of 18 studies involving 5587 participants revealed a significant correlation between the presence of MELF pattern and heightened LNM incidence (OR 3.52, 95% CI: 2.17-5.71, p < 0.001). Univariate analysis indicated a notable inverse relationship between MELF pattern and OS (HR 2.31, 95% CI: 1.67-3.21, p < 0.001), as well as DFS (HR 1.67, 95% CI: 1.20-2.30, p = 0.002). In multivariate analysis, however, this association did not achieve statistical significance (for OS, HR 1.54, 95% CI: 0.99-2.41, p = 0.056; for DFS, HR 1.25, 95% CI: 0.90-1.74, p = 0.191). The findings of this meta-analysis demonstrated that the MELF pattern was linked to elevated risk of LNM and poorer OS and DFS outcomes. The correlation was influenced by various factors including surgical interventions and adjuvant therapies. While potentially increasing the risk of recurrence, the findings did not demonstrate statistical significance (OR 1.15, 95% CI: 0.61-2.16; p = 0.669).
子宫内膜癌（EC）中微囊状、细长状和碎片状（MELF）浸润模式的预后意义尚未完全阐明。本研究对五个电子数据库（PubMed、EMBASE、Cochrane、Web of Science和中国知网（CNKI））进行了从建库至2025年4月的系统检索。评估重点为总生存期（OS）、无病生存期（DFS）、淋巴结转移（LNM）和复发率（RR）等主要结局。通过对总比值比（OR）和风险比（HR）以及相应的95%置信区间（CI）进行荟萃分析计算，阐明了MELF模式对临床结局的影响。对18项涉及5587名参与者的研究分析显示，MELF模式的存在与LNM发生率升高之间存在显著相关性（OR 3.52，95%CI：2.17 - 5.71，p < 0.001）。单因素分析表明，MELF模式与OS（HR 2.31，95%CI：1.67 - 3.21，p < 0.001）以及DFS（HR 1.67，95%CI：1.20 - 2.30，p = 0.002）之间存在显著的负相关关系。然而，在多因素分析中，这种关联未达到统计学意义（对于OS，HR 1.54，95%CI：0.99 - 2.41，p = 0.056；对于DFS，HR 1.25，95%CI：0.90 - 1.74，p = 0.191）。该荟萃分析的结果表明，MELF模式与LNM风险升高以及较差的OS和DFS结局相关。这种相关性受到包括手术干预和辅助治疗在内的多种因素影响。虽然可能增加复发风险，但研究结果未显示出统计学意义（OR 1.15，95%CI：0.61 - 2.16；p = 0.669）。
