| Background:Cervical cancer is one of the common malignant tumors in gynecology.With the popularization of cervical lesion screening,more and more patients with early cervical cancer have been found,and the incidence of cervical cancer tends to be younger.About 40% of cervical cancer occurs in women of childbearing age,some of them still have reproductive requirements.Therefore,preserving fertility function becomes an important demand of these patients.Radical trachelectomy was first reported by Dargent et al in 1994,after more than 20 years of development,surgical techniques have been relatively mature,appropriate patients with early cervical cancer can achieve similar oncological outcomes with radical hysterectomy after radical trachelectomy,and can obtain a certain pregnancy rate.In recent years,under the premise of considering the safety of tumors,clinicians have to undergo neoadjuvant chemotherapy to “degrade” the tumor staging and then perform fertility-sparing surgery to cervical cancer patients who wish to preserve fertility but have a larger mass exceed the surgical indications,However,the sample size of neoadjuvant chemotherapy combined with surgery is small,and the feasibility needs to be confirmed.Objective:In this paper,a single rate meta-analysis of the literature about radical trachelectomy and neoadjuvant chemotherapy combined with surgery for early cervical cancer to preserve fertility were conducted to preliminarily evaluate oncological and pregnancy outcomes in patients with early cervical cancer receiving treatment.Method: Searching of Cochrane database,PubMed and Chinese full-text database systematically,and comprehensive collection the relevant literatures about the preservation of fertility in patients with early cervical cancer from January 1998 to December 2018 for radical trachelectomy and neoadjuvant chemotherapy combined with surgery.Screening results were performed according to literature inclusion and exclusion criteria,and RevMan5.3 software was used for single rate meta-analysis,in order to evaluate comprehensively the recurrence rate,pregnancy rate,abortion rate,premature delivery rate and live birth rate after treatment.Result:48 were included in this study,of which 41 were in the radical trachelectomy group,2555 cases in total,and the final number of cases of radical trachelectomy was 2356(92.21%),the ratio of different stages are IA1 6.22%、IA2 12.92%、IB1 79.33%、IB2 1.10%、IIA 0.43%.Meta-analysis showed that the recurrence rate after radical trachelectomy combined with OR=0.06(95% CI: 0.05-0.08),pregnancy rate combined with OR = 0.28(95% CI: 0.23-0.34),abortion rate combined with OR=0.43(95% CI: 0.37-0.50),premature delivery rate combined with OR=0.49(95% CI: 0.39-0.60),live birth rate combined with OR=1.67(95% CI: 1.35-2.06),then after formula conversion,the recurrence rate was 5.66%,pregnancy rate was 21.88%,abortion rate was 30.07%,premature delivery rate was 32.89%,and live birth rate was 62.55%.In addition,there were 9 literatures in the radical trachelectomy group that clearly described the size and recurrence of cervical cancer,subgroup analysis based on the critical criterion of mass diameter 2 cm showed that 483 cases of cervical cancer had mass diameter less than 2 cm and 112 cases had mass diameter more than 2 cm.The result showed that the recurrence rate of cervical cancer patients with mass diameter > 2 cm after RT was significantly higher than that of those with mass less than 2 cm(combined OR=7.18,95% CI:3.36-13.96,P<0.00001).In the neoadjuvant chemotherapy combined with surgery group,there were 7 literatures,103 cases in total,and 86 cases(83.50%)underwent fertility-sparing surgery after neoadjuvant chemotherapy.The recurrence rate could not be analyzed because of the different operation methods after neoadjuvant chemotherapy.In addition,there were 5 literatures which analyzed the outcome of the premature delivery because 2 literatures did not describe the condition of premature delivery.Meta-analysis showed that pregnancy rate combined with OR=0.67(95% CI:0.42-1.06),abortion rate combined with OR=0.24(95%CI: 0.13-0.41),premature delivery rate combined with OR=4.74(95% CI: 2.43-9.27),live birth rate combined with OR=2.44(95% CI: 1.22-4.88),after formula conversion,pregnancy rate 40.12%,abortion rate 19.35%,premature delivery rate 82.58%,live birth rate 70.93%.Conclusion:1.Radical trachelectomy is a safe and effective surgical procedure for patients with early cervical cancer who want to preserve fertility.It can achieve relatively good oncological outcomes,especially for patients with a tumor diameter ≤ 2 cm.2.Compared with patients with cervical cancer whose mass diameter are less than 2 cm,those with mass diameter greater than 2 cm have a higher risk of recurrence after radical trachelectomy.3.After radical trachelectomy,a certain pregnancy rate can be obtained,although the abortion rate and premature delivery rate are higher,the final live birth rate is relatively good.4.Neoadjuvant chemotherapy combines with fertility-sparing surgery may become a fertility-preservation treatment for patients with large cervical cancer mass,but it is still in the experimental stage and needs to be confirmed by large sample studies. |
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