| Background:Endometrial carcinoma is one of the common malignant genital tumors in Chinese women.In recent years,the incidence of endometrial carcinoma has gradually increased and gradually become younger,seriously threatening w omen's life and health.Early diayear survival rate.But for the high-risk,adva nced and postoperative recurrence of endometrial carcinoma patients will face more life-threatening,Now the principle of cancer treatment:standardization,i ndividualization,rationalization,so we are forced to seek a new treatment:ne oadjuvant chemotherapy,for several courses of chemotherapy before surgery.However,due to the lack of strong and evidence-based medical evidence for neoadjuvant chemotherapy in endometrial carcinoma in worldwide.Therefore,to explore a safe and effective treatment by evidence-based medicine for maxim izing the cure rate of patients is of great significance to improve the survival rate of patients.Objective:Study high-risk,advanced,postoperative recurrences,and specific types of endometrial carcinoma treatment.To evaluate the neoadjuvant chemotherapy an d routine surgery for endometrial carcinoma from clinical efficacy,operative ti me,adverse reactions(liver and kidney dysfunction,bone marrow suppression,gastrointestinal reactions,infections),intraoperative blood loss,etc.Methods:According to Systematic Review in Health Care:Meta-analysis in Context,For questions to be evaluated,determine inclusion and exclusion criteria.To establish a search strategy and online search of Pubmed,Cochrance Library,Medline,OVID,Web of science,Chinese Journal Full-text Database(CNKI),VIP and Wanfang Database database from January 2001to December 2017.The t wo reviewers independently selected the study,assessed the quality of the stu dy,and extracted the data.Meta-analysis of the included articles was done usi ng Review Manager 5.3 software.Results:The two reviewers included a total of 8 articles based on the inclusion and exclusion criteria,relating to neoadjuvant chemotherapy for endometrial carci noma versus conventional surgery.Use Review Manager 5.3 software for meta-analysis,The results showed that:(1)With the clinical efficacy rate as the obs ervation index,4 articles were included,of which 187 were neo-adjuvant che motherapy and the total number of routine operations was 187.The heterogen eity analysis showed that I2=0%.Smallness,good homogeneity,using a fix ed effect model,combined analysis results show:RR=1.49,95%CI(1.25,1.79),and Z=4.34,P<0.0001,P<0.05,the difference between the two gro ups of data With statistical significance,neoadjuvant chemotherapy in advance d endometrial carcinoma can be considered more effective than conventional s urgery.(2)Taking the time of surgery as the observation index,2 articles were included.The total number of patients undergoing neoadjuvant chemotherapy was 47 and the total number of routine operations was 71.The heterogeneity analysis showed that I2=0%,ie the heterogeneity of the studies included.Small,good homogeneity,using a fixed effect model,combined analysis result s showed:SMD=-0.64,95%CI(-1.03,-0.25),and Z=3.19,P=0.001,P<0.05,two sets of data The difference was statistically significant,so it can be considered that the surgery time after neoadjuvant chemotherapy for advan ced endometrial carcinoma is shorter than the initial surgery.(3)With adverse re actions as the observation index,a total of 3 articles were included.The total number of neoadjuvant chemotherapy patients was 236 and the total number of routine operations was 236.The heterogeneity analysis showed that I~2=0%,that is,the included studies were heterogeneous.Smallness,good homoge neity,using a fixed effect model,combined analysis results showed:RR=0.50,95%CI was(038,0.64),and Z=5.28,P<0.00001,P<0.05,the differen ce between the two groups of data Statistically significant,it can be considere d that late-stage endometrial cancer with neoadjuvant chemotherapy+surgery co mpared to conventional surgery+conventional chemotherapy after the occurrenc e of adverse reactions less likely.(4)Taking the intraoperative blood loss as the observation index,a total of 2 articles were included in the analysis,among which 57 patients underwent neoadjuvant chemotherapy for endometrial cance r and 77 patients underwent routine surgery.The heterogeneity analysis results showed that I~2=98%,and the included studies were heterogeneous with a ran domized model,P=0.56,P>0.05.There was no statistically significant differen ce between the two groups.Conclusion:1.Neoadjuvant chemotherapy for advanced endometrial carcinoma is more effective than conventional surgical treatment and is a more effective treatment for advanced endometrial carcinoma.2.Late-stage endometrial carcinoma undergoing neoadjuvant chemotherapy followed by surgery was shorter than the initial surgery.3.Late neoadjuvant carcinoma with neoadjuvant chemotherapy+surgery than conventional surgery+postoperative chemotherapy combined with adverse reactions to chemotherapy was lower. |
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