A Meta-analysis On Death Risk Factors Of Uterine Carcinosarcoma

Objective:To systematically analyze the death risk factors of uterine carcinosarcoma using the method of meta-analysis,which can indirectly reflect the prognosis of the disease,thus provide theoretical basis for clinical practice.Methods :A systematical search was conducted to find the related studies about the death risk factors of uterine carcinosarcoma,using databases such as Pub Med?EM base?Medline?Web of science ?CNKI?Wan fang Data?VIP Data and so on.The languages were limited to Chinese and English.We searched for non-randomized controlled trials?randomized controlled trials?cohort and case-control studies related to the death risk factors of uterine carcinosarcoma until December 31 th,2016.The studies were evaluated and screened independently by two researchers according to the inclusion criteria and exclusion criteria.After the information extraction and data collection,we use Rev Man5.3 for statistic analysis.Results:8 studies were finally selected using the inclusion criteria and exclusion criteria,including 6 Chinese studies and 2 foreign studies.we used the Meta-analysis to evaluate,the results were as follows:(1)age had no significant influence on the mortality of uterine carcinosarcoma patients;(2)later tumor FIGO stage leaded to higher mortality of uterine carcinosarcoma patients,and the difference was significant(OR=0.11,95%CI [0.05,0.24],P<0.00001);(3)poorer tumor grade leaded to higher mortality of uterine carcinosarcoma patients,and the difference was significant(OR=0.09,95%CI[0.01,0.77],P=0.03);(4)there were significant differences between different tumor sizes,and greater tumor size leaded to higher mortality of uterine carcinosarcoma patients(OR=0.23,95%CI[0.09,0.62],P=0.003);(5)different carcinomatous components had differences in the mortality of uterine carcinosarcoma patients,the endometrial adenocarcinoma leaded to lower mortality of uterine carcinosarcoma patients(OR=0.32,95%CI[0.11,0.95],P=0.04),but the conclusion was unreliable;(6)different histological types of sarcomatous component had no statistic differences in the mortality of uterine carcinosarcoma patients;(7)different depths of invasion had significant influence on the mortality of uterine carcinosarcoma patients,deeper myometrium invasion leaded to higher mortality of uterine carcinosarcoma patients(OR=0.11,95%CI[0.05,0.24],P<0.00001);(8)the postoperative residual lesions significantly influenced the mortality of uterine carcinosarcoma patients,greater postoperative residual lesions leaded to higher mortality of uterine carcinosarcoma patients(OR=0.07,95%CI[0.01,0.55],P=0.01);(9)the mortality of uterine carcinosarcoma patients with lymph nodes metastasis was significantly higher(OR=0.15,95%CI[ 0.06,0.37],P<0.0001);(10)lymph vascular space invasion had significant relationship with the mortality of uterine carcinosarcoma patients,it leaded to higher mortality of uterine carcinosarcoma(OR=0.28,95%CI[ 0.10,0.78],P=0.01),but the conclusion was unrelible;(11)Postoperative adjuvant chemotherapy and auxiliary postoperative radiotherapy had no difference on the mortality of uterine carcinosarcoma patients.Conclusion:1?Later FIGO stage?poorer tumor grade?greater tumor size?deeper myometrium invasion?greater postoperative residual lesions and lymph nodes metastasis are the death risk factors of uterine carcinosarcoma patients.2?Age?histological type of sarcomatous are not the death risk factors of uterine carcinosarcoma patients.adjuvant chemotherapy and adjuvant radiotherapy had no difference on the mortality of uterine carcinosarcoma patients.3?Carcinomatous and lymph vascular space invasion component maybe the death risk factor of uterine carcinosarcoma patients,but the conclusion is unreliable.4?arity?menstruation situation?cervical invasion may not be the death risk factor of uterine carcinosarcoma patients,but the number of related study is only one,we need more information to confirm the conclusion.