| Objective: To adopt a systematic review to analyze the risk factors of recurrence in patients with Epithelial borderline ovarian tumors after fertility preservation surgery.Methods: A computer was used to search Pub Med,Web of Science,EMbase,CNKI,Wan Fang Data,VIP and other databases.From the establishment of the database to September 25,2020,all the databases were collected to study the risk of postoperative recurrence of epithelial BOT patients with fertility preservation surgery Factor cohort studies or case-control studies,combined with manual search to collect relevant domestic journals and magazines,references in relevant studies,and other research related to the research topic.The selection of literature,data extraction,and risk assessment of bias were completed by two researchers simultaneously and independently according to the inclusion and exclusion criteria.The combined effect analysis of the final included study used Rev Man5.3 software for meta-analysis.Results: The full text was finally included in 25 cohort studies with a total of3265 patients.Five studies reported the postoperative recurrence rate of patients with unilateral and bilateral ovarian tumors.A total of 450 patients were enrolled.There were 390 patients with unilateral ovarian tumors,of which 57 had recurrences;there were 60 patients with bilateral ovarian tumors,of which 18 cases of recurrence.The meta-analysis showed that compared with the postoperative recurrence rate of patients with unilateral ovarian tumors(14.62%),the postoperative recurrence rate of patients with bilateral ovarian tumors(30.00%)was significantly higher(OR=2.73,95%CI: 1.41～5.30,P=0.003).Fourteen studies reported the postoperative recurrence rate of SBOT and MBOT patients.A total of 1711 patients were enrolled.There were861 SBOT patients,including 217 recurrences.There were 850 MBOT patients,including 126 recurrences.The meta-analysis results showed that compared with MBOT patients,the postoperative recurrence rate of SBOT patients(25.00%vs14.82%)was significantly higher(OR=1.61,95%CI: 1.24 to 2.09,P<0.001).17 studies reported the postoperative recurrence rate of patients with ovarian cystectomy and unilateral adnexectomy.A total of 2146 patients were enrolled.A total of 736 patients with ovarian cyst removal,including 177 recurrences;a total of 1410 patients with unilateral adnexectomy,including 181 cases relapse.The meta-analysis results showed that compared with patients with unilateral adnexectomy,the postoperative recurrence rate of patients with ovarian cystectomy(24.05% vs 12.84%)was significantly higher(OR=1.82,95%CI: 1.42 to 2.34,P<0.001).Thirteen studies reported the postoperative recurrence rate of patients undergoing laparoscopic and laparotomy.A total of 2596 patients were enrolled.There were 851 patients undergoing laparoscopic surgery,including 179 recurrences.There were 1745 patients undergoing open surgery,of which 294 recurred.The results of meta-analysis showed that there was no significant difference in postoperative recurrence rate between patients undergoing laparoscopic surgery and open surgery,and the difference was not statistically significant(OR=1.04,95%CI: 0.82 to 1.32,P=0.76).Eight studies reported the postoperative recurrence rate of patients with unilateral and bilateral ovarian tumors.A total of 1,400 patients were enrolled,and a total of 576 patients with fully staged surgery,including 49 recurrences;a total of 824 patients with incomplete stage surgery,of which 135 were relapse.The results of the meta-analysis showed that compared with patients with comprehensive staging surgery,the postoperative recurrence rate(16.38% vs 8.51%)of patients without comprehensive staging surgery was significantly higher(OR=2.11,95%CI: 1.13～3.95,P=0.02).In this study,a total of 3 groups of studies included more than 9documents.The results of Begg’s test showed that the funnel plots of the 3 groups of studies with more than 9 documents were all symmetrical,and the possibility of publication bias was low.Conclusion: Bilateral ovarian tumors,SBOT,ovarian cystectomy and incomplete staging are the risk factors for recurrence after surgery for epithelial BOT patients with fertility-sparing surgery. |
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