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目的系统评价保留生育功能手术与根治性手术相比治疗早期卵巢上皮性癌的有效性。方法计算机检索Pub Med、EMbase、The Cochrane Library(2016年8期)、Web of Science、CBM、Wan Fang Data和CNKI数据库,搜集有关保留生育功能手术与根治性手术治疗早期卵巢上皮性癌的相关研究,检索时限均为建库至2016年8月10日。由2位研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用Stata 12.0软件进行Meta分析。结果共纳入8个研究,包括2 561例患者。Meta分析结果显示:与根治性手术相比,保留生育功能手术治疗早期卵巢上皮性癌后患者的总体生存率[单变量分析:RR=1.03,95%CI(0.98,1.07);多变量分析:RR=0.81,95%CI(0.52,1.28)]、无病生存率[单变量分析:RR=1.02,95%CI(0.96,1.09);多变量分析:RR=1.24,95%CI(0.65,2.39)]和术后疾病复发率[RR=0.86,95%CI(0.57,1.30)]方面,差异无统计学意义;同时与根治性手术相比,保留生育功能手术后IA期患者总体生存率[RR=0.99,95%CI(0.98,1.02)]、无病生存率[RR=1.01,95%CI(0.95,1.06)]和IC期患者总体生存率[RR=0.95,95%CI(0.86,1.04)]、无病生存率[RR=0.94,95%CI(0.80,1.11)]方面,差异无统计学意义。结论保留生育功能手术治疗早期卵巢上皮性癌不会明显增加其复发率或降低生存率,手术方式不是影响患者预后的主要因素。受纳入研究的数量和质量的限制,上述结论尚需要更多研究予以证实。
Objective To evaluate the effectiveness of preserving reproductive function in the treatment of early stage epithelial ovarian cancer compared with radical surgery. Methods We searched Pub Med, EMbase, The Cochrane Library (2016 issue 8), Web of Science, CBM, Wan Fang Data and CNKI database for the study of the relationship between fertility-preserving surgery and radical surgery in the treatment of early stage epithelial ovarian cancer , The search time limit is to build the library until August 10, 2016. Two researchers independently screened the literature, extracted the data, and assessed the risk of bias in the included studies. Meta-analysis was performed using Stata 12.0 software. Results A total of 8 studies were included, including 2,561 patients. Meta-analysis showed overall survival of patients with preserved ovarian function after surgical treatment of early-stage ovarian cancer compared with radical surgery (univariate analysis: RR = 1.03, 95% CI, 0.98, 1.07). Multivariate analysis: RR = 0.81, 95% CI (0.52, 1.28)], disease-free survival [Univariate analysis: RR = 1.02,95% CI 0.96,1.09; Multivariate analysis RR = 1.24,95% CI 0.65, 2.39)] and postoperative recurrence rate [RR = 0.86,95% CI (0.57,1.30)], the difference was not statistically significant; meanwhile, compared with radical surgery, the overall survival rate of patients with stage IA retained after fertility surgery (RR = 0.95, 95% CI, 0.98, 1.02), disease-free survival (RR = 1.01, 95% CI 0.95, 1.06) and overall survival , 1.04)], disease-free survival [RR = 0.94,95% CI (0.80,1.11)], the difference was not statistically significant. Conclusion Preservation of reproductive function in the treatment of early stage epithelial ovarian cancer does not significantly increase the recurrence rate or reduce the survival rate. The surgical method is not the main factor affecting the prognosis of patients. Due to the limited number and quality of studies included, the above conclusion still needs more research to be confirmed.