| Objects:Uterine sarcoma is a very rare malignant tumor of female genital tract derived from interstitial tissue,uterine smooth muscle tissue or connective tissue.Its pathological types are complex and diverse,and preoperative diagnosis is difficult.According to NCCN guidelines,the standard treatment for uterine sarcoma is whole uterus.Resectionħbilateral salpingo-oophorectomy?BOS?,and the need for lymphade-nectomy?LAD?is currently controversial[1].Attachment metastasis occurs in only about 3%of patients with early Uterine leiomyosarcoma?uLMS?,and the 5-year survival rate was not independently affected by the ovariectomy[2].For early Endometrial stromal sarcoma?ESS?patients before perimenopause,ovarian retention is controversial due to the dual effects of high recurrence caused by postoperative hormone replacement therapy and perimenopausal symptoms during the clinical diagnosis and treatment[3,4].Based on the theory of evidence-based medicine,this paper collects published research data on the effect of lymphadenectomy and ovariectomy on the prognosis of uterine sarcoma,and discusses the impact of these two methods on the prognosis of uterine sarcoma.Methods:Apply computer search to English databases such as Pubmed and Cochrane Library,and Chinese databases such as Wanfang Medical Net and China Knowledge Network?CNKI?to search online for relevant literature on prognostic factors analysis of uterine sarcoma lymphadenectomy and ovariectomy,and manually search References and journals for related research.The retrieval time starts from the database construction to December 2019.The retrieved literature was screened,evaluated for quality,extracted and analyzed according to the Cochrane systematic review method.The data of the screened literature were divided into exposed and non-exposed groups according to whether other surgical treatments were added on the basis of pure hysterectomy.The exposed components were the lymphadenectomy?LAD?group and bilateral salpingo-oophorectomy?BOS?group,which were separately counted and discussed.Finally,the statistical analysis software Stata was used to analyze the HR of survival risk and the recurrence rate RR to study the influence of surgical methods on the prognostic factors of patients with uterine sarcoma.Results:Through computer search,208 articles were initially retrieved,and24 studies were included after strict selection.The included literature included 22 English and 2 Chinese literatures.The types of studies were cohort studies and pathological controlled studies,including patients 4544.people.Because of the greater heterogeneity in the LAD group?survival hazard ratio study group:I2=58.1,P=0.008;relapse rate study group:I2=62.5,P=0.006?,the random effect model was selected as a whole and further sensitive.Sexuality analysis examines sources of heterogeneity.The BOS group has less heterogeneity?survival risk ratio study group:I2=0,P=0.612;relapse rate study group:I2=47.7,P=0.039?.The study groups have homogeneity,and fixed effect models are used for calculation.Statistics.Meta analysis results are as follows:?1?compared with simple hysterectomy,the combined survival hazard ratio of patients with uterine sarcoma plus LAD is 1.05?95%CI=0.82-1.34?,the difference is not statistically significant;?2?compared with simple Compared with hysterectomy,the recurrence rate of patients with hysterosarcoma plus LAD combined with an OR value of 0.80?95%CI=0.61-1.06?,the difference was not statistically significant;?3?compared with hysterectomy alone,patients with uterine sarcoma The combined hazard ratio of additional BOS was 0.71?95%CI=0.42-1.18?,and the difference was not statistically significant.?4?Compared with simple hysterectomy,the recurrence rate of patients with uterine sarcoma plus BOS combined with an OR value of 0.49?95%CI=0.34-0.70?,the difference was statistically significant.Conclusions:1.LAD has no effect on the overall survival rate and recurrence rate of uterine sarcoma,and routine LAD is not recommended for patients.2.BOS can reduce the recurrence rate of patients with uterine sarcoma,but it has no effect on overall survival rate.For young,early-stage patients,an individualized plan needs to be formulated when ovarian preservation is performed,considering the advantages and disadvantages. |
PDF Full Text Request