The Feasibility Of Ovarian Conservation For Young Patients With Early-stage Cervical Adenocarcinoma:A Meta-analysis

Background: 20%-25% of cervical cancer patients are cervical adenocarcinoma.More than 30% of cervical adenocarcinoma patients are <45 years old,and the 5-year survival rate of patients with early cervical adenocarcinoma was high,with approximately 88% of stage I and approximately 67% of stage II.It has long been recognized that ovarian conservation for cervical squamous cell carcinoma.However,patients with cervical adenocarcinoma of stage IA-IIA mostly had the removal of bilateral ovaries during operation in the past.This surgery has many complications such as vaginal atrophy,osteoporosis,Alzheimer's disease,and cardiovascular events.Therefore,the problem of ovary conservation in early cervical adenocarcinoma has been controversial.This article aims to explore ovarian preservation ovaries in young patients with early-stage cervical adenocarcinoma and the risks and outcomes of those patients.Objects: 1.To identify the risk factors for ovarian metastasis of early-stage cervical adenocarcinoma.2.To evaluate the feasibility of ovarian conservation for young patients with early-stage cervical adenocarcinoma,and the effect of preserving ovaries on the survival rate of patients with cervical adenocarcinoma.Methods: Related databases at home and abroad were searched through computer,including English databases such as Pubmed,Embase,and The Cochrane library,and Chinese Biomedical Literature Database(CBM),Chinese Knowledge Database(CNKI),Wanfang,VIP,and other Chinese databases.The search period is up to March 2018,the journals of Chinese Obstetrics and Gynecology and Chinese Journal of Practical Gynecology and Obstetrics were manually searched.The languages were Chinese and English.The research types included case-control studies,and cohort studies in non-randomized controlled trials.Two researchers screened according to the defined inclusion criteria and exclusion criteria,retained the documents that met the standards,and evaluated the literature quality.Then the relevant data of the literature were extracted,and Meta analysis was performed using Rev Man 5.3 software to analyze the heterogeneity and publication bias,sensitivity analysis and subgroup analysis were performed if necessary.Data extracted in this study included: 1 Age 2 FIGO stage 3 Surgical methods 4 Ovarian metastases 5 Postoperative follow-up times 6 Postoperative survival and ovarian outcomes 7 Lymph node metastasis,parametrial infiltration,tumor diameter,lymphatic vessel space infiltration and other clinical pathology factors related to ovarian metastases.Results: 1.Finally,18 articles were included in the study,including 10 English articles,8 Chinese articles.There were 2 cohort studies,and the rest were retrospective non-randomized controlled studies.There was a total of 3930 cases of cervical adenocarcinoma with surgical treatment included,of which 483 were ovarian preserved and 3447 with bilateral oophorectomy.2.Meta-analysis showed that:(1)There was no statistically significant difference in ovarian metastasis between patients younger than 45 years and those older than 45 years(P = 0.09).(2)The ovarian metastasis rate of cervical adenocarcinoma in stage IA patients was approximately 0%,and 2.78% of stage IB.The overall metastasis rate of stage I was approximately 2.70%.The ovarian metastasis rate of cervical adenocarcinoma in stage II A patients was approximately 8.67%,and 12.3% of stage II B.The overall metastasis rate of stage II was approximately 10.51%.Compared with stage II patients,the rate of ovarian metastasis in stage I patients were much lower(P<0.00001).(3)There was no significant difference in postoperative survival risk between patients with unilateral ovary or bilateral ovaries preserved and those with bilateral oophorectomy(P = 0.78).(4)Tumor diameter(P=0.0006),parametrial infiltration(P<0.0001),lymph node metastasis(P=0.0005),uterine copus involvement(P<0.0001),lymphovascular space involvement(P=0.0005)were all independent risk factors for ovarian metastasis in early-stage cervical adenocarcinoma.Deep stroma invation(P=0.77)may not be an independent risk factor of ovarian metastasis.Conclusion: 1.Age has no effect on ovarian metastasis of early cervical adenocarcinoma.2.The ovarian metastasis rate of patients with stage I cervical adenocarcinoma is low,and it is feasible for ovarian preservation.3.Overian preservation has no effect on the patient's postoperative survival risk in stage I cervical adenocarcinoma.4.In stage I cervical adenocarcinoma,tumor diameter greater than 4cm,parametrial invasion,lymph node metastasis,uterine copus invasion,and lymphovascular space involvement are independent risk factors for ovarian metastasis.Deep cervical stroma(more than one-half of the depth)infiltration may not be an independent risk factor for ovarian metastasis.