| Objective:Through Meta analysis,comprehensively evaluate the risk factors affecting the prognosis and fertility status of ovarian borderline tumors after fertility conservation surgery,so as to provid evidence-based medical evidence for the optimization of clinical treatment of ovarian borderline tumors.Methodology:Adequately searched Chinese databases include: China National Knowledge Network(CNKI),Wanfang database,VIP periodical database;foreign databases include: Pub Med,The Cochrane Library,WEB OF SCIENCE and EMbase until December 2022,and collected clinical research literatures on fertility conservation surgery for ovarian borderline tumors that were published,and tracked related cited literatures and references.Two researchers independently screened the literature in strict accordance with the inclusion and exclusion criteria,then NOS scale was used to evaluate the literature quality.The recurrence rate,survival rate,pregnancy rate and full-term delivery rate after fertility preservation treatment were taken as evaluation indexes,and meta-analysis was performed on the extracted data by Rev Man5.4software.Results:In this study,a total of 18 literatures related to fertility conservation surgery for the treatment of ovarian borderline tumors were finally selected,all of which were English literatures and retrospective studies.All the literatures included were evaluated by NOS scale with a score of more than 7 points.A total of 3865 patients were included,3084 of them in the fertility function preservation group and the other781 patients undergoing radical surgery.A total of 16 studies were conducted to analyze the recurrence after fertility conservation,and 447 patients had recurrence among 2684 patients.After formula conversion,the recurrence rate after fertility function preservation was calculated to be 13.0%(95%CI: 9.1%-19.4%).There were6 studies on the recurrence of patients after radical surgery,and 36 patients had recurrence among 781 patients,and the recurrence rate was 4.6%(36/781).Compared with fertility conservation surgery,the postoperative recurrence rate was statistically different(OR=3.30,95%CI:1.68-6.46).Deaths were reported in a total of 11 studies,with 12 deaths observed among 2204 patients,a mortality rate of 0.5%(12/2204).There were 15 studies on pregnancy after fertility conservation,among which 1295 patients were willing to become pregnant and 690 patients were pregnant after surgery.After formula conversion,ther pregnancy rate after fertility conservation was calculated to be 60.5%(95%CI: 46.2%-73.3%),there were 11 studies on the live birth rate,a total of 785 pregnancies and 643 live births,a live birth rate of 81.9%.A meta-analysis was conducted on the factors affecting postoperative recurrence and fertility in 18 studies,and the results were as follows.(1)Compared with patients FIGO stageⅠand FIGO stageⅡ-Ⅳ,FIGO stageⅡ-Ⅳpatients showed a higher recurrence rate,with statistical difference(OR=0.18,95%CI:0.10-0.35),and no significant difference in pregnancy rate(OR=0.94,95%CI:0.63-1.39).(2)Compared with patients undergoing unilateral addenectomy and ovarian mass resection,the recurrence rate of ovarian mass resection was higher with statistical difference(OR=0.67,95%CI:0.52-0.85),and there was no significant difference in pregnancy rate(OR=0.91,95%CI:0.68-1.24).(3)There was no statistically significant difference in recurrence rate(OR=2.02,95%CI:0.87-4.70)and pregnancy rate(OR=0.53,95%CI:0.11-2.50)between patients who received adjuvant chemotherapy and those who did not.(4)There was no statistically significant difference in the recurrence rate(OR=0.82,95%CI:0.63-1.07)OR in the pregnancy rate(OR=0.97,95%CI:0.74-1.29)between patients treated with laparoscopic surgery and those treated with laporotomy surgery.(5)Compared with patients with serous tumors,patients with mucous tumors had a statistically lower recurrence rate(OR=0.50,95%CI:0.31-0.81),and there was no statistically significant difference in pregnancy rate(OR=1.25,95%CI:0.70-2.22).(6)Compared with patients with bilateral tumors,patients with unilateral tumors had a statistically lower recurrence rate(OR=0.26,95%CI:0.18-0.37),and there was no statistically significant difference in pregnancy rate(OR=1.58,95%CI:0.95-2.61).(7)Compared with patients without micropapillae in tissue types,patients with micropapillae had a higher recurrence rate,with statistical difference OR=2.16,95%CI:1.15-4.09)。Conclusion:1.The postoperative recurrence rate of ovarian borderline tumor treated by fertility conservation surgery is higher than that treated by radical surgery,but the mortality rate is lower,and the long-term survival rate is not significantly affected.Fertility conservation surgery is safe and feasible in the treatment of ovarian borderline tumor.2.FIGO stage Ⅱ-Ⅳ,bilateral ovarian tumors,serous tumors and micropapillae in tissue types are risk factors for postoperative recurrence in BOT patients.Unilateral laparoscopic adnexectomy is recommended for BOT patients,and postoperative adjuvant chemotherapy is not necessary for BOT patients.3.Tumor staging,surgical method,surgical approach,postoperative adjuvant chemotherapy,histological type,and ovarian involvement have no significant influence on postoperative fertility function,and there is a considerable pregnancy rate and live birth rate after fertility preservation surgery. |
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