| Objective:To study the related cases of the gastric-type adenocarcinoma of the cervix(GAS)by using meta analysis.And the clinical manifestations,diagnostic methods,pathological characteristics,treatment and prognosis of GAS were comprehensively discussed to provide evidence-based medical evidence for clinical work.Methods:By fully retrieving Chinese database such as CNKI、Wanfang、VIP and CBM Database and English database such as Pub Med、Embase、Web of Science database from the establishment of the library to November 2020,to collect and select the related case reports or retrospective clinical case analysis of GAS based on inclusion and exclusion criteria.The quality of the included study was evaluated according to the MINORS scale.Extract individual patient data(IPD)information: age,course of disease,history or family history of related diseases,clinical manifestations,diagnostic methods,pathological features,FIGO clinical stages,treatment modalities,follow-up time and patient outcome.Statistical analysis was carried out by using Stata 15.1 software.Calculated the ratio and 95% confidence interval(CI)for the non-control dichotomy counting data,drew the survival analysis curve using Kaplan-Meier,performed comparative analysis of classified variables using Fisher precision tests,used Cox proportional risk regression model for prognostic analysis,and calculated the Hazard Ratio(HR)and 95%CI.Results:According to the literature retrieval strategy,333 patients from 80 case reports and 45 retrospective clinical case analysis reports were selected according to the inclusion and exclusion criteria.1.The age of onset of GAS was 20-86 years old,the average age was 45.57 years,the median age was 46 years.2.The course of GAS was 0.25-252 months,the average onset time was21.9 months,and the median time was 8 months.3.In cases reporting clinical features,vaginal mucus-like or watery secretions was the most common,approximately 60.86%(199/327),95%CI was[54.99,66.73];irregular vaginal/contact bleeding accounted for about50.76%(166/327),95%CI was [44.92,56.61];the lower abdominal distention was about 16.82%(55/327),95%CI was [11.25,22.39];the symptom of "urinary incontinence" was about 1.53%(5/327),95%CI was [0.11,2.94];fever accounted for about 1.22%(4/327),95%CI was [0.00,2.45].4.In cases reporting clinical signs,cervical hypertrophy accounted for approximately 47.74%(137/287),95%CI was [33.63,61.84];cervical hardness accounted for approximately 33.80%(97/287),95%CI was[21.20,46.39];different degrees of cervical erosion accounted for about33.45%(96/287),95%CI was [22.49,42.41];cervical smoothness accounted for about 24.39%(70/287),95%CI was [17.42,31.36];about 22.65%(65/287)of cervical neoplasm or mass was visible,95%CI was [14.04,31.26];cervical canal thickening accounted for about 20.21%(58/287),95%CI was[3.54,36.88];about 14.29%(41/287)of parietal tissue were involved,95%CI was [5.57,23.00];invasion of the vaginal wall or vaginal fornix accounted for about 11.15%(32/287),95%CI was [3.77,18.53];about 10.45%(30/287)of patients with uterine enlargement,95%CI was [5.51,15.40].5.The imaging features of pelvic ultrasound、MRI and CT were reported respectively in 107、45 and 24 cases.41 cases with pelvic ultrasound were abnormal echo and cervical space occupying lesions,24 cases with MRI signs indicating enlarged cervix,10 cases with CT showed uterine cavity or cervical canal dilatation and cervical space occupying lesions.6.The levels of the preoperative serum tumor marker such as SCCA、CEA、CA125、CA199 were not significantly different between patients at I(early stage)and II、III、IV(advanced stage),with P values of 0.31、1.00、0.64、0.63 respectively.7.The positive rate of HPV detection was 5.36%(3/56),and those patients with HPV positive were also with CIN;the positive rate of cervical cytology with cervical was 14.87%(29/195),which often required repeated examination.8.The diagnosis of GAS by preoperative pathological examination accounted for about 50.38%(132/262)of the reported cases,95%CI was[37.98,62.78],the detection rate of single cervical biopsy was19.85%,multiple cervical biopsy(2-5 times)or cervical conization was29.00%.Immunohistochemical results:the positive rate of ER was3.75%(3/80),95%CI was [0.00,9.36];the positive rate of PR was3.28%(2/61),95%CI was [0.00,7.98];the positive rate of P16 was31.11%(14/45),95%CI was [17.35,44.87];the positive rate of Ki-67 was98.20%(109/111),95% CI was [95.57,100],the positive rate of CK7 was94.74%(36/38),95%CI was [87.00,100];the positive rate of CK20 was45.83%(11/24),95%CI was [7.16,84.51];the positive rate of CDX2 was41.67%(5/12),95%CI was [8.95,74.38];the positive rate of CEA was95.63%(153/160),95%CI was [92.23,99.02];the positive rate of P53 was86.72%(111/128),95%CI was [78.09,95.34];the positive rate of PCNA was76.19%(16/21),95%CI was [51.58,100];the positive rate of HIK1083 was83.33%(5/6),95%CI was [40.49,100];the positive rate of Vimentin was61.54%(8/13),95%CI was [30.94,92.14];the positive rate of MUC6、SMA、EMA、AB/PAS were 100%(21/21,27/27,10/10,39/39).9.Of the 333 patients included,7.81% were associated with PJS(26/333),9.30% with ovarian serous、mucinous tumors or sex cord tumors with annular tubule(31/333),and only 1 with LS.10.The treatment of GAS was mainly surgical treatment(196/213).Stage I 、II、III and IV accounted for 42.25% 、38.50%、15.49% and 3.76% of all FIGO-reported cases(90/213 、82/213、33/213、8/213),respectively.The prognosis of patients of stage I was better than that of II、III、IV patients(P<0.01);the 5-year survival rate of patients of stage I 、II、III and IV was 73.95%、24.38%、10.91% and 0%.Conclusions:1.The increase of vaginal mucus-like or watery secretions is the most common clinical symptom of GAS.The common clinical signs are cervical hypertrophy and hard quality.The detection rate of routine cervical cancer screening was low.MRI examination of GAS is more characteristic than ultrasound and CT.Preoperative MRI can be used to evaluate the condition of confirmed patients,individualized treatment options,and postoperative combined CA125 、 CA199 detection for curative effect evaluation and condition monitoringand the early.2.The diagnosis of GAS depends on cervical biopsy.The early diagnostic accuracy of multiple deep cervical biopsies(>8 mm)、cervical conization or cervical scratch was higher than that of conventional cervical biopsies.The combination of multiple immunohistochemical markers(ER、PR、MUC6、AB/PAS、SMA、EMA、HIK1083、Ki-67、CK7、CK20、CDX2、CEA、Vimentin、P16、PCNA、P53)can effectively assist in the diagnosis.3.The prognosis of GAS is poor,and difference of FIGO clinical stage are important factors affecting prognosis.The prognosis of patients of stage I is obviously better than that of stage II、III、IV.4.Gene detection is of great significance to patients with GAS.It can not only detect the possible mucinous lesions in the gastrointestinal tract and other parts of the reproductive tract in time,so as to actively intervene and delay the progress of the disease,but also determine the relevant molecular targets,which is beneficial to targeted therapy and improve prognosis. |
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