背景:在I期上皮性卵巢癌(EOC)患者中,保留生育力手术(FSS)与根治性手术(RS)相比的肿瘤学结果仍然是一个争论的话题。我们评估了接受FSS和RS的I期EOC患者预后的风险比(RR)。
方法:我们对PubMed进行了系统搜索,WebofScience,和Embase为截至2023年11月29日发表的文章。不涉及外科手术或包括怀孕患者的研究被排除。我们计算了无病生存率的RR,总生存率,和复发率。使用非随机干预研究中的Cochrane偏差风险(ROBINS-I)工具评估纳入研究的质量。荟萃分析在PROSPERO(CRD42024546460)上注册。
结果:从5,529篇潜在相关文章中,我们确定了83篇文章进行初步筛选,并在最终的荟萃分析中包括12篇文章,包括2,906例上皮性卵巢癌患者。两组无病生存率无显著差异(RR[95%置信区间{CI}],0.90[0.51,1.58];P=0.71),总生存率(RR[95%CI],0.74[0.53,1.03];P=0.07),和复发率(RR[95%CI],1.10[0.69,1.76];P=0.68)。在敏感性分析中,仅在总生存率方面观察到显著差异(排除前:RR[95%CI],0.74[0.53-1.03],P=0.07;排除后:RR[95%CI],0.70[0.50-0.99];P=0.04)。
结论:这是第一个也是唯一一个比较无病生存率的个体患者数据的荟萃分析,总生存率,早期上皮性卵巢癌患者行FSS和RS的复发率。FSS与RS相似的无病生存率和复发风险。我们假设FSS组的总生存率下降不能归因于上皮性卵巢癌的远处转移。
BACKGROUND: The oncological outcomes of fertility-sparing surgery (FSS) compared to radical surgery (RS) in patients with stage I epithelial ovarian cancer (EOC) remain a subject of debate. We evaluated the risk ratios (RRs) for outcomes in patients with stage I EOC who underwent FSS versus RS.
METHODS: We conducted a systematic search of PubMed, Web of Science, and Embase for articles published up to November 29, 2023. Studies that did not involve surgical procedures or included pregnant patients were excluded. We calculated the RRs for disease-free survival, overall survival, and recurrence rate. The quality of the included studies was assessed using the Cochrane Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) tool. The meta-analysis was registered on PROSPERO (CRD42024546460).
RESULTS: From the 5,529 potentially relevant articles, we identified 83 articles for initial screening and included 12 articles in the final meta-analysis, encompassing 2,906 patients with epithelial ovarian cancer. There were no significant differences between the two groups in disease-free survival (RR [95% confidence interval {CI}], 0.90 [0.51, 1.58]; P = 0.71), overall survival (RR [95% CI], 0.74 [0.53, 1.03]; P = 0.07), and recurrence rate (RR [95% CI], 1.10 [0.69, 1.76]; P = 0.68). In sensitivity analyses, the significant difference was observed only for overall survival (before exclusion: RR [95% CI], 0.74 [0.53-1.03], P = 0.07; after exclusion: RR [95% CI], 0.70 [0.50-0.99]; P = 0.04).
CONCLUSIONS: This is the first and only individual patient data meta-analysis comparing disease-free survival, overall survival, and recurrence rate of patients with early-stage epithelial ovarian cancer undergoing FSS and RS. FSS was associated with similar disease-free survival and risk of recurrence as RS. We hypothesized that the decreased overall survival in the FSS group could not be attributed to distant metastases from epithelial ovarian cancer.