| Background:Ovarian cancer is a common malignant tumor in women all over the world.Since the early stage of ovarian cancer is often asymptomatic and late also lacks effective treatment,the death rate of ovarian cancer ranks first in gynecologic malignant tumors,which seriously threatens the health and life of women.There are different types of ovarian cancer.Epithelial ovarian cancer is the most common type,accounting for 95%.About 14% of the cases were younger than 40 years old,and 7%to 8% of patients with early epithelial ovarian cancer were below 35 years old.With the change of women’s fertility requirements,how to retain the fertility function of the patients has become a hot spot in the treatment of epithelial ovarian cancer.Since the 80 s of last century,fertility preserving surgery has been carried out for young patients with early epithelial ovarian cancer.In view of the recurrent and metastatic nature of epithelial ovarian cancer,what is the prognosis and pregnancy outcome after fertility preserving therapy? There are fewer reports on it now.In this study,meta analysis is done on the related research literatures.Objective:To evaluate the prognosis and pregnancy outcome of patients with young stage I epithelial ovarian cancer treated with fertility preserving therapy by Meta analysis.Methods:Through the computer retrieval of PubMed,Chinese knowledge network,Wan Fang and other databases,from January 1980 to January 2018,the prognosis and pregnancy outcome related literature of young stage I patients with epithelial ovarian cancer were collected.Inclusion criteria:(1)the cases included patients with primary stage I epithelial ovarian cancer;(2)the age of the included patients was less than 40 years of age;(3)no other tumor or no other tumor treatment history.Exclusion criteria:(1)the subjects did not distinguish the age segment;(2)there was no statistical analysis of the prognosis and pregnancy outcome in the literature,no clear follow-up interceptions;(3)the literature of repeated reports;(4)except for the pathologicallyproved borderline tumors.According to the inclusion and exclusion criteria,the collection of literature was screened strictly,the MINORS items were used to evaluate the quality of the literature included in the study.The RevMan 5.3 software was used to carry out Meta analysis on the reproductive function of young stage I patients with epithelial ovarian cancer,and the recurrence rate,mortality rate,pregnancy rate and live birth rate within 5 years after the treatment of fertility preservation were observed and evaluated comprehensively.Results:(1)There were 22 articles related to fertility preserving treatment in young stage I epithelial ovarian cancer patients.986 patients were covererd.The FIGO stage was stage IA 586 cases(59.4%),stage IB 16 cases(1.7%),stage IC 384 Cases(38.9%).The degree of differentiation was high differentiation in 672 cases(68.2%),moderately differentiated in 148 cases(15%),poorly differentiated in 66 cases(6.7%),and other unspecified 100 cases(10.1%).Histological types were ovarian mucinous carcinoma in 560 cases(56.8%),ovarian serous carcinoma in 124 cases(12.6%),ovarian endometrioid carcinoma in 162 cases(16.4%),ovarian clear cell carcinoma in114 cases(11.6%)and other 26 cases(2.6%).601 patients were treated by surgery combined with chemotherapy,and 385 patients underwent surgery alone.The average follow-up time of all the literature was 38~122 months.The average age of all patients ranged from 23.2 to 36.5 years.(2)The recurrence rate,mortality,pregnancy rate,and live yield OR value and95% confidence interval were 13.8%(9.9% ~ 18%),9.9%(7.4% ~ 12.3%),56.5%(47.4% ~ 65.2%)and 83.7%(79.6% ~ 87.1%)in 5 years after the treatment of the young stage I patients with epithelial ovarian cancer.The recurrence rate and death rate were 11.5%(9.1% to 14.5%)and 6.5%(3.8% to 12.3%)within 5 years after operation combined with chemotherapy,and the recurrence rate and mortality rate were 16.7%(11.5% to 23.7%)and 13%(9.9% to 16.7%)within 5 years after surgery alone.(3)According to FIGO staging,histopathological types and postoperative chemotherapy.The number of cases in IB phase and other histological types was less,so they were excluded from the statistical requirements.(1)the recurrence rate andmortality OR value and 95% confidence interval within 5 years after the treatment of IA young epithelial ovarian cancer were 9.1%(7.4% to 11.5%)and 4.8%(3.8% to7.4%).The recurrence rate and death rate within 5 years after the treatment of IC young epithelial ovarian cancer and the OR value of death rate and the 95%confidence interval were 14.5%(14.5%).10.7% to 18.7%)and 9.9%(7.4% ~13.7%).(2)16 articles studied the relationship between postoperative prognosis and pathological tissue types in young I patients with epithelial ovarian cancer.The recurrence rate OR value and 95% confidence interval of the patients with mucinous,endometrium,serous and transpar-ent epithelial ovarian cancer were 11.5%(8.3% ~15.3%),17.4%(11.5% to 24.8%),24.8%(16% ~ 36.7%)and 29.1%(19.4% ~41.2%).Within 5 years,the death rates were 6.5%(4.8% ~ 10.7%),11.5%(5.7% to21.3%),17.3%(10.7% to 27%),20.6%(20.6% to 27%).(3)10 articles studied the relationship between pregnancy and chemotherapy in young stage I epithelial ovarian cancer.The OR value of pregnancy rate and 95% confidence interval in 5 years after operation combined chemotherapy and simple operation were 49.2%(34.2% to64.3%)and 50.7%(35.9% to 65.6%).Conclusions:1.For the young and reproductive I patients with epithelial ovarian cancer,especially in the IA stage,it is feasible to follow closely the follow-up observation after the choice of reproductive function treatment.Better prognosis and pregnancy outcome can be obtained.2.The recurrence rate and mortality rate of young stage I patients with epithelial ovarian cancer were 11.5% and 6.5% in 5 years after operation combined with chemotherapy,which was lower than the recurrence rate(16.7%)and mortality rate(13%)within 5 years after the simple operation.The pregnancy rate was 49.2%within 5 years after the operation combined with chemotherapy,there was no significant difference in pregnancy rate(50.7%)compared with simple operation.It is suggested that fertility preserving surgery combined with chemotherapy can improve the prognosis of young stage I epithelial ovarian cancer,and the pregnancy outcome is similar to that of simple surgery.3.The prognosis of stage I epithelial ovarian cancer patients with serous,mucous,endometrium and transparent cell type of epithelial ovarian cancer is different,and the rate of recurrence and mortality of young stage I ovarian clear cell carcinoma in the 5 year period is the highest. |
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