年轻早期子宫内膜癌患者孕激素治疗的Meta分析

发布时间：2018-05-26 23:16

本文选题：子宫内膜癌 + 孕激素　；参考：《大连医科大学》2014年硕士论文

【摘要】：背景：子宫内膜癌(endometrial carcinoma，EC)是常见的女性生殖系统恶性肿瘤之一，近年来子宫内膜癌的发病率有升高趋势，其中年轻患者的发病率增长迅速。I期子宫内膜癌的传统治疗方案是全子宫双附件切除术，必要时行盆腹腔淋巴结切除术，然而，许多尚未生育的年轻患者常强烈要求保留生育功能。近年来孕激素在年轻早期患者保留生育功能中的治疗作用已得到肯定，但是对于孕激素治疗的安全性、有效性等问题未达成共识。目的：利用Meta分析的方法，对年轻早期子宫内膜癌患者孕激素治疗的安全性、有效性、妊娠时机及生育后治疗等问题进行分析，以期对子宫内膜癌保留生育功能治疗提供一定的参考依据。方法：通过计算机检索Pubmed数据库、Medline数据库、OVID数据库、Science Direct数据库、Cochrane Library数据库、中国知网(CNKI)、中国生物医学文献数据库(CBM)、万方数据库等。收集所有关于40岁以下IA期高分化子宫内膜癌应用孕激素治疗的文献，检索语言限于中文和英文，检索时间不限。纳入原始研究资料，进行资料提取并核对，剔除不符合纳入标准的文献，并利用R软件（R2.13.1）做单个样本率的Meta分析，，对疾病的完全缓解率、复发率以及治疗后孕产情况进行分析。结果:根据上述检索方法，按照严格的纳入排除标准进行筛选，最后共有10篇文献入选，共有391例患者，提取相关资料行进行统计分析。结果示:孕激素治疗的总完全缓解率57.07%，CI [0.5111;0.6282]，总的复发率35.37%，CI[0.2786;0.4367]，总的妊娠率36.19%，CI [0.3046;0.4234]，总的分娩率34.22%，CI [0.2819;0.4081]。从入选的资料完整的6篇文献中，提取完全缓解后复发及治疗无效后接受手术治疗的患者资料，分析孕激素治疗后的疾病结局，结果示：中位随访39.5个月，34例接受手术的患者，5.88%（2/34）出现疾病进展，97.06%（33/34）的患者无瘤生存，仅2.94%（1/34）的患者术后复发。结论 1.年轻早期子宫内膜癌孕激素治疗的总完全缓解率57.07%，总的复发率35.37%，且完全缓解后复发以及治疗无效的患者在接受全面分期手术后，其预后较直接手术患者的预后无明显差异，表明孕激素治疗是安全可行的。 2.孕激素保留生育功能治疗的总妊娠率36.19%，总分娩率34.22%，表明孕激素在子宫内膜癌患者保留生育功能治疗是有效的。 3.完成孕激素治疗后积极应用辅助生殖技术有望提高妊娠率及分娩率。 4.保守性手术（如宫腔镜手术）联合孕激素治疗较单纯应用孕激素治疗安全，妊娠率高。 5.完成生育后应进行全面分期手术，未手术者需密切随访，定期宫腔镜下诊刮监测内膜情况。
[Abstract]:Background: endometrial carcinoma (EC) is one of the most common malignant tumors in the female reproductive system. The incidence of endometrial carcinoma has been increasing in recent years. Among them, the traditional treatment for stage I endometrial cancer in young patients with rapidly growing incidence is total hysterectomy and pelvic lymphadenectomy, where necessary. However, Many young patients who have not yet given birth often urge retention of fertility. In recent years, the therapeutic effect of progesterone on the retention of reproductive function in young and early stage patients has been affirmed, but there is no consensus on the safety and effectiveness of progesterone therapy. Objective: to analyze the safety, efficacy, timing of pregnancy and postnatal treatment of progesterone in young early endometrial carcinoma patients by Meta analysis. In order to provide a certain reference for the treatment of endometrial carcinoma reserved fertility function. Methods: the Pubmed database, Medline database, Direct database, Cochrane Library database, Chinese biomedical literature database and Wanfang database were searched by computer. To collect all the literature on the treatment of highly differentiated endometrial carcinoma under 40 years of age with progesterone. The search languages are limited to Chinese and English, and the search time is unlimited. The original research data were collected and checked, and the documents that did not meet the inclusion criteria were eliminated. The Meta analysis of single sample rate was made by using R software R2.13.1. the complete remission rate, recurrence rate and pregnant and parturient status after treatment were analyzed. Results: according to the above search method, according to the strict inclusion exclusion criteria, 10 articles were selected, 391 patients were selected, and the relevant data were extracted for statistical analysis. The results showed that the total complete remission rate of progesterone treatment was 57.07 CI [0.5111 卤0.6282], the total recurrence rate was 35.37g CI [0.2786 卤0.4367], the total pregnancy rate was 36.19CI [0.30460.0.4234], the total delivery rate was 34.22g CI [0.28190.4081]. The data of patients with relapse after complete remission and those who received surgical treatment after complete remission and ineffective treatment were extracted from 6 articles of complete data, and the outcome of the disease after progesterone therapy was analyzed. The results showed that 34 patients with operation were followed up for a median of 39.5 months (5.88 / 34) with disease progression 97.06% 33 / 34), and only 2.94% (1 / 34) recurred after operation. Conclusion 1. The total complete remission rate was 57.07 and the total recurrence rate was 35.37 in the young early stage endometrial carcinoma treated with progesterone. The prognosis of the patients with relapse after complete remission and ineffective treatment was not significantly different from that of the patients undergoing direct operation. It shows that progesterone therapy is safe and feasible. 2. The total pregnancy rate and delivery rate were 36.19 and 34.222.The results indicated that progesterone was effective in the treatment of endometrial carcinoma. 3. Positive application of assisted reproductive technology after progesterone therapy is expected to increase pregnancy rate and delivery rate. 4. Conservative surgery (such as hysteroscopic surgery) combined with progesterone therapy is more safe than the use of progesterone alone, the pregnancy rate is high. 5. The patients without operation should be followed up closely and the endometrium should be monitored by hysteroscopic curettage.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33

【参考文献】