背景:POLE突变子宫内膜癌可能是一种亚特异性肿瘤类型,具有更良好的预后。3级(G3或高级别)子宫内膜样癌仍然是一个临床难题,一些肿瘤表现为低级别肿瘤,另一些表现出更具攻击性的行为。
目的:确定POLE突变状态与G3子宫内膜样子宫内膜癌(EC)患者总生存期(OS)和无进展生存期(PFS)之间的关系。我们还旨在确定G3子宫内膜样EC中POLE突变的患病率。
方法:我们根据系统评价和荟萃分析(PRISMA)指南(PROSPERO号:CRD4202340008)的首选报告项目进行了系统评价。我们搜索了以下电子数据库:PubMed/Medline,EMBASE,科克伦图书馆,Scopus,和WebofScience。对于事件发生时间数据,使用风险比(HRs)和相应的95%置信区间(CIs)描述了G3EC中POLE突变的影响.如果可从研究作者获得,则调查每个研究的个体患者数据。如果没有患者个人数据,使用适当的方法提取有关事件发生时间结局的信息.OS和PFS使用一阶段和两阶段方法进行分析,Kaplan-Meier方法,和Cox比例风险模型。
结果:本系统综述和荟萃分析纳入了19项研究,纳入了3092例子宫内膜样高发患者。POLE突变患者的死亡风险较低(HR=0.36,95%CI0.26至0.50,I2=0%,10项试验)和疾病进展(HR=0.31,95%CI0.17至0.57,I2=33%,10个试验)。POLE突变的合并患病率为11%(95%CI9至13,I2=68%,18项研究)。
结论:高度子宫内膜样EC的POLE突变与OS和PFS增加的更有利的预后相关。
POLE mutated endometrial carcinomas may represent a subspecific type of tumors harboring a more favorable prognosis. Grade 3 (G3 or high-grade) endometrioid endometrial carcinomas remain a clinical dilemma, with some tumors behaving as the low-grade counterparts and others presenting a more aggressive behavior.
To determine the association between POLE mutational status and the overall-survival (OS) and progression-free-survival (PFS) of patients with G3 endometrioid endometrial cancer (EC). We also aimed to determine the prevalence of
POLE mutations in G3 endometrioid EC.
We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO No: CRD4202340008). We searched the following electronic databases: PubMed/Medline, EMBASE, Cochrane Library, Scopus, and Web of Science. For time-to-event data, the effect of
POLE mutation in G3 EC was described using hazard ratios (HRs) and corresponding 95% confidence intervals (CIs). Individual patient data for each study was investigated if available from the study authors. If individual patient data were not available, information regarding time-to-event outcomes was extracted using an appropriate methodology. OS and PFS were analyzed using both one-stage and two-stage approaches, the Kaplan-Meier method, and Cox-proportional hazards models.
This systematic review and meta-analysis included 19 studies with 3092 patients who had high-grade endometrioid EC. Patients with POLE mutations had lower risks of death (HR = 0.36, 95% CI 0.26 to 0.50, I2 = 0%, 10 trials) and disease progression (HR = 0.31, 95% CI 0.17 to 0.57, I2 = 33%, 10 trials). The pooled prevalence of
POLE mutation was 11% (95% CI 9 to 13, I2 = 68%, 18 studies).
POLE mutations in high-grade endometrioid EC are associated with a more favorable prognosis with increased OS and PFS.