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目的系统评价嗜神经侵袭(PNI)对早期宫颈癌患者预后的影响。方法计算机检索PubMed、EMbase、The Cochrane Library(2016年10期)、CNKI、WanFang Data、CBM、VIP数据库,搜集PNI与早期宫颈癌预后相关性的病例-对照研究,检索时间截止至2016年10月。由两名评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险评价后,采用Rev Man 5.3软件进行统计分析。结果最终纳入8篇文献,共7个病例-对照研究,1 218例患者。Meta分析结果显示:(1)Cox比例风险模型进行多因素生存分析,PNI不是影响无瘤生存率(DFS)[HR=0.73,95%CI(0.33,1.58),P=0.42]和总生存率(OS)[HR=0.89,95%CI(0.41,1.94),P=0.77]的独立因素;(2)Kaplan-Meier生存曲线分析,PNI阳性组的总体DFS[HR=1.86,95%CI(1.20,2.88),P=0.006]和OS[HR=2.43,95%CI(1.63,3.62),P<0.000 1]明显低于PNI阴性组,差异有统计学意义。结论目前还没有证据表明宫颈癌PNI是影响预后的独立因素,但是作为影响宫颈癌DFS和OS的不良因素之一,可考虑成为制定术后辅助治疗方案的一个指标。鉴于纳入研究的局限性,上述结论还需要大样本前瞻性对照研究来进一步验证。
Objective To evaluate the effect of neural invasion (PNI) on the prognosis of patients with early cervical cancer. METHODS: A case-control study was conducted using PubMed, EMbase, The Cochrane Library (2016, 10), CNKI, WanFang Data, CBM and VIP database to collect the correlation between PNI and the prognosis of early cervical cancer. The search time was up to October 2016 . Two reviewers independently screened literature, extracted data, and evaluated the included risk assessment for the study, using the Rev Man 5.3 software for statistical analysis. Results Finally included 8 articles, a total of 7 cases - control study, 1 218 cases of patients. Meta-analysis showed that: (1) Multivariate survival analysis was performed in the Cox proportional hazards model. PNI did not affect the DFS (HR = 0.73, 95% CI 0.33, 1.58, P = 0.42) and overall survival (2) The Kaplan-Meier survival curve analysis showed that the overall DFS in the PNI-positive group (HR = 1.86,95% CI ( 1.20,2.88), P = 0.006] and OS [HR = 2.43,95% CI (1.63,3.62), P <0.000 1] were significantly lower than those in PNI negative group, the difference was statistically significant. Conclusion There is no evidence that cervical cancer PNI is an independent prognostic factor, but as one of the adverse factors affecting cervical cancer DFS and OS, it can be considered as an indicator of postoperative adjuvant therapy. In view of the limitations of inclusion studies, these conclusions also require large sample prospective controlled studies to further validate.