Meta Analysis Of Clinical And Pathological Features Of Endometrial Carcinoma In Young Women

In recent years,the incidence of endometrial carcinoma（EC）continues to rise, with theextension of average life expectancy of women, fertility change in concept as well as thewidely use of exogenous estrogen. EC patients who are younger than45years of ageconstitute are increasing year by year,getting younger and younger. It’s reported that patientswith EC under the age of45years old account for12.7%of all similar patients.Sofar,domestic and outside studies about clinical and pathological features of EC in youngpatients is limited in number.In particular,prospective and randomized controlled clinicaltrials about young EC treatment are lacked. It’s of significance to study and summarize theproblems of younger EC as well as the clinical and pathological features of young patientsfor the prevention and treatment of EC and improving the quality of life of patients.Objective：To compare the clinical and pathological data of young EC patients with elder patientsby using Meta-analysis，the core method of evidenced-based medicine.Exploring the uniqueclinical and pathological features of young patients with EC and providing a reference forthe early prevention,diagnosis and treatment of EC.Methods：A thorough literature search was performed among Ovid-medline（1995-2011）,Pubmed,CNKI,CBMdisc,Wanfang,Weipu database through internet,aiming atthe clinical case-control study about clinical and pathological features of young and elderpatients with EC.All the literatures are further selected by rigid criteria formed in advance toinclude or exclude samples.The included literatures were evaluated by the evaluationprinciples of case-control research literature and the data was extracted by self-designeddata-extracting tables.All the data extracted was put in RevMan5.0software and analyzed by it.The binaryvariable was analyzed by OR.The research heterogeneity was judged by the results ofheterogeneity test-P value,which manifested in the forest plots.The combined statistic wascalculated by solid-effect model for the index with homogeneity,and by random-effect modelfor the index with heterogeneity.Statistic significance is judged by the Z value or P value resulting from the combined statistic manifested in the forest plots.The sensitivity analysiswas performed in solid-effect model and random-effect model at the same time,either by ORor RR.The publication bias was analyzed by the Egger test method and the degree ofasymmetry manifested in the funnel plots.Results：1.According to the inclusion and exclusion criteria,18papers were finally included,3ofwhich in English and15in Chinese.Evaluated the papers in accordance with the principle ofcase-control study literature.7papers were high quality research scored≥15,while11paperswere low quality scored＜15.High quality research is less than low quality research.2.Thecombined analysis of clinical features of young and elder EC patients manifested that:（1）High risk factors：Neither the incidence of nulliparity or infertility or polycystic ovarysyndrome had the homogeneity（P＜0.1），but both had significant difference between youngand elder EC patients（Z=8.77，P＜0.00001；Z=3.27，P=0.001）.（2）Clinical features：Neither the incidence of menstral disorder or vaginal bleeding after menopause had thehomogeneity（P＜0.1），while both had significant difference between young and elder ECpatients（Z=8.95，P＜0.00001；Z=8.84，P＜0.00001）.The incidence of hypertension hadthe homogeneity（P≥0.1）and had significant difference between young and elder EC patients（Z=6.62，P＜0.00001）.Neither the incidence of obesity or diabetes had the homogeneity（P＜0.1），and both had no significant difference between young and elder EC patients（Z=1.46，P=0.14；Z=0.92，P=0.36）.Moreover, the incidence of abnormal vaginal drainagehad the homogeneity（P＜0.1）and had no significant difference between young and elder ECpatients（Z=0.62，P=0.54）.3. The combined analysis of pathological features of young andelder EC patients manifested that:Both the incidence of endometrioid adenocarcinoma andpositive rate of ER/PR had the homogeneity（P≥0.1）and had significant difference betweenyoung and elder EC patients（Z=2.65，P=0.008；Z=4.70/Z=4.91，P＜0.00001）. Neither theincidence of high differentiation of histological grade or the none or≤1/2myometrialinvasion had the homogeneity（P＜0.1），while had significant difference between young andelder EC patients（Z=4.21，P＜0.0001；Z=6.02，P＜0.00001）. The incidence of surgical-pathological staging of I-II phase had the homogeneity（P≥0.1）and had no significantdifference between young and elder EC patients. The incidence of lymph nodes metastaseshad the homogeneity（P＜0.1）and had no significant difference between young and elder EC patients（Z=0.14，P=0.89）.The results of sensitivity analysis showed that all the results werestable and had no significant difference.The publication bias analysis showed that theincidence of nulliparity or infertility, polycystic ovary syndrome, surgical-pathologicalstaging of I-II phase and pathological type of endometrioid adenocarcinoma were slightasymmetry in funnel plots and Egger test obtained P value＜0.05,suggesting the publicationbias.While other index showed no publication bias.Conclusion：The Meta-analysis finds that young patients with EC have their own unique clinicalfeatures,and the majority have risk factors such as nulliparity or infertility, polycystic ovarysyndrome. menstrual disorder is often happened that as the main clinical manifestations ofyoung patients with EC.Incidence of hypertension in young patients is lower than which ofelder women.While the incidence of obesity and diabetes have no significant differencebetween young and elder patients with EC.Young patients have a better differentiation,lessmyometrial invasion and higher positive rate of ER/PR than elder patients with EC.Butthere are no significant difference of surgery-pathological staging and abdominal lymphnode metastasis between young and elder patients with EC.Combined with the uniqueclinical and pathological features of young patients,suggesting that the prognosis may bebetter in young patients than that in elder patients.As the included literatures in this study areall the case-control study which argument strength is low，and there are certain publicationbias in part of the analysis results，so the research findings and choice on the treatment of theyoung patients with EC are still need to be further confirmed by high-quality case-controltest and larege sample prospective study.