Feasibility Of Ovarian Preservation In Young Women With Endometrial Cancer:a Meta-Analysis

BackgroundEndometrial cancer is one of the common gynecological malignancies, and typically affected postmenopausal women. The conventional surgical approach is extrafacial hysterectomy and bilateral salping-oophorectomy. However,the incidence of young patients in recent years increases rapidly, about15%of patients of endometrial cancer are premenopausal women and5%of patients are under the age of40.Ovariectomy has a significant negative influence on patients in cardiovascular disease, bone metabolism, cognitive function and sexual life. The problem of whether young patients can retain the ovaries needs the gynecologic workers to solve. To determine the feasibility of ovarian preservation in young women under45years old with stage Ⅰ, this meta-analysis was performed.Objective:Estimate the feasibility of preserving ovarian in young endometrial caner patients of stage Ⅰ by tumor-specific survival and overall survival.Methods:We search PUBMED database, Cochrane Library database, EMBAS database, MEDLINE database, CNKI database, Wanfang database, Chinese Biomedical Literature Database (CBM) in the Internet. We also hand-search three journals of Obstetrics and Gynecology (Chinese journal of Obstetrics and Gynecology, Progress in Obstetrics and Gynecology, Chinese journal of Practical Gynecology and Obstetrics). The language includes English and Chinese. The experiment group underwent hysterectomy, and the control group underwent hysterectomy and bilateral salping-oophorectomy. Evaluate the collected trials and exclude trails that not meet the purpose.Results:Totally three articles are included. Extract relevant data and survival curves to perform a meta-analysis by Revman5.1. There is no heterogeneity among the trials, so a fixed-effect model can be used, and the results are as follows:There is no significant difference in tumor-specific survival (HR=0.54,95%CI:0.16-1.86, P=0.33) and overall survival(HR=0.66,95%CI:0.38-1.13, P=0.13).Conclusion:Ovarian preservation in young women under45years old with stage I maybe safe, but because a small number of patients with poorly differentiated and stage Ib tumors are included, the result should be interpreted with caution, and we should be careful in the choice of surgical approach, choose the patients with stage la and endometrioid adenmocacinoma to save ovary. The trials included are not enough to avoid the existence of bias, so we need more randomized controlled trials of high quality to confirm the conclusions.