子宫癌肉瘤死亡危险因素的meta分析

发布时间：2018-04-15 01:08

本文选题：子宫癌肉瘤 + 死亡　；参考：《吉林大学》2017年硕士论文

【摘要】：研究目的:通过meta分析,运用循证医学的方法综合分析子宫癌肉瘤患者死亡的危险因素,间接反映疾病的预后,为临床决策提供理论依据。研究方法:通过计算机系统检索Pub Med、EMbase、Medline、Web of science等外文数据库及中国知网(CNKI)、万方数据库、维普中文期刊全文数据库、优秀博硕士论文等中文数据库,检索时限截止至2016年12月31日,搜集所有与子宫癌肉瘤患者死亡危险因素相关的非随机对照试验、随机对照试验、队列研究及病例对照研究,并追踪纳入文献的参考文献。语言限定为中文和英文。由2名研究人员根据纳入标准及排除标准对文献进行独立筛查、评价和资料提取。根据meta分析的要求对资料进行收集和整理,应用Rev Man5.3软件进行Meta统计分析。研究结果:本研究通过制定的纳入标准和排除标准对文献进行严格筛选,最终纳入8篇文献,其中中文文献6篇,英文文献2篇。应用Newcastle-Ottawa Scale(NOS量表)对文献质量进行评价,均符合标准。对各因素纳入的相应研究进行Meta分析,结果显示(1)不同年龄分组的子宫癌肉瘤患者的死亡率无明显差异;(2)肿瘤FIGO分期晚的子宫癌肉瘤患者死亡率高,且差异具有统计学意义(OR=0.11,95%CI[0.05,0.24],P0.00001);(3)肿瘤分化程度低的子宫癌肉瘤患者的死亡率高,且差异存在统计学意义(OR=0.09,95%CI[0.01,0.77],P=0.03);(4)肿瘤直径大的子宫癌肉瘤患者的死亡率高,且差异有统计学意义(OR=0.23,95%CI[0.09,0.62],P=0.003);(5)癌性成分为子宫内膜样腺癌的子宫癌肉瘤患者的死亡率低,且差异具有统计学意义(OR=0.32,95%CI[0.11,0.95],P=0.04),敏感性分析显示该结论敏感性高,可靠性差;(6)肉瘤成分不同的两组子宫癌肉瘤患者的死亡率不存在明显统计学差异;(7)子宫肌层浸润程度深的子宫癌肉瘤患者的死亡率高,并且差异具有统计学意义(OR=0.11,95%CI[0.05,0.24],P0.00001);(8)术后残余病灶直径大的子宫癌肉瘤患者的死亡率高,且差异具有统计学意义(OR=0.07,95%CI[0.01,0.55],P=0.01);(9)有淋巴结转移的子宫癌肉瘤患者的死亡率高,且差异具有统计学意义(OR=0.15,95%CI[0.06,0.37],P0.0001);(10)有淋巴脉管间隙浸润(LVSI)的子宫癌肉瘤患者的死亡率高,且差异具有统计学意义(OR=0.28,95%CI[0.10,0.78],P=0.010.05),但敏感性分析显示该结论敏感性较高,可靠性差;(11)术后辅助化疗或术后辅助放疗的两组子宫癌肉瘤患者的死亡率无明显统计学差异。研究结论:1、肿瘤FIGO分期晚、肿瘤分化程度低、肿瘤直径大、子宫肌层浸润程度深、术后有残余病灶、有淋巴结转移是子宫癌肉瘤患者死亡的危险因素。2、年龄、肉瘤成分不是子宫癌肉瘤患者死亡的危险因素。术后辅助化疗和术后辅助放疗对子宫癌肉瘤患者死亡的影响两者无明显差别。3、癌性成分为非子宫内膜样腺癌、存在淋巴脉管间隙浸润(LVSI)可能是子宫癌肉瘤患者死亡的危险因素,但该结论可靠性差,需要更多研究证据的验证。4、孕产次、绝经情况、宫颈侵犯可能不是子宫癌肉瘤患者的死亡的危险因素,但本次研究纳入的文献数目均只有1篇,论证强度很小,可能导致统计分析结果存在较大误差,研究结果需要更多高质量、大样本的研究提供可靠数据加以分析。
[Abstract]:Objective: through meta analysis, the risk factors of death in patients with uterine carcinosarcoma of the comprehensive analysis method of evidence-based medicine, indirectly reflect the prognosis of the disease, and provide a theoretical basis for clinical decision making. Methods: through computer retrieval system of Pub Med, EMbase, Medline, Web of science and Chinese HowNet database (CNKI). Wanfang database, VIP Chinese CNKI, Chinese dissertation database, retrieval time deadline to December 31, 2016, collect all the risk factors of uterine cancer and sarcoma death related non randomized controlled trials, randomized controlled trials, cohort study and case study, and tracking of literature reference language is defined as. Chinese and English. By 2 researchers according to inclusion criteria and exclusion criteria for independent evaluation and screening of the literature, the data were extracted according to the meta analysis. Requirements for the collection and collation of data, using Rev Man5.3 Meta software for statistical analysis. Results: the study by the inclusion and exclusion criteria rigorous screening of the literature, a total of 8 trials were included, of which 6 articles Chinese, English 2 references. The application of Newcastle-Ottawa Scale (NOS scale) to evaluate the quality conforms to the standard. The corresponding research into the factors of Meta analysis, the results showed no significant difference (1) uterine carcinosarcoma patients with different age group mortality; (2) the mortality rate for patients with sarcoma of uterine cancer tumor FIGO stage is high, and the difference was statistically significant (OR=0.11,95%CI[0.05,0.24], P0.00001) (; 3) a low degree of tumor differentiation in patients with uterine carcinosarcoma of the high mortality rate, and the difference wasstatistically significant (OR=0.09,95%CI[0.01,0.77], P=0.03); (4) the large diameter of the tumor of uterine cancer sarcoma patients The mortality rate is high, and the difference was statistically significant (OR=0.23,95%CI[0.09,0.62], P=0.003); (5) cancer components of uterine carcinosarcoma were endometrioid adenocarcinoma of the lower death rate, and the difference was statistically significant (OR=0.32,95%CI[0.11,0.95], P=0.04), sensitivity analysis shows that the conclusion of high sensitivity and reliability; (6) sarcoma different compositions of two groups of uterine carcinosarcoma mortality in patients with no obvious statistical difference; (7) uterine carcinosarcoma were deep myometrial invasion and high mortality, the difference has statistical significance (OR=0.11,95%CI[0.05,0.24], P0.00001); (8) postoperative residual tumor diameter in patients with large uterine carcinosarcoma and high mortality, and the difference was statistically significant (OR=0.07,95%CI[0.01,0.55], P=0.01); (9) with uterine carcinosarcoma patients with lymph node metastasis. The mortality rate is high, and the difference was statistically significant (OR=0.15,95 %CI[0.06,0.37], P0.0001); (10) lymph vascular space invasion (LVSI) of uterine sarcoma patients with high mortality, and the difference was statistically significant (OR=0.28,95%CI[0.10,0.78], P=0.010.05), but the sensitivity analysis shows that the conclusion of higher sensitivity, poor reliability; (11) radiotherapy and adjuvant chemotherapy or postoperative two groups of uterus carcinosarcoma of mortality in patients with no significant difference. Conclusion: 1, tumor FIGO stage, tumor differentiation, tumor diameter, myometrial invasion depth, postoperative residual lesions, lymph node metastasis is.2, the risk factors of death in patients with uterine carcinosarcoma of the age, the risk factors of death sarcoma no uterine carcinosarcoma patients. Adjuvant chemotherapy and postoperative adjuvant radiotherapy.3 no significant difference effect on mortality in patients with uterine carcinosarcoma both into cancer divided into non endometrioid adenocarcinoma, there are shower Pakistan vascular space invasion (LVSI) may be a risk factor for death in patients with carcinosarcoma of the uterus, but the reliability is poor, need more evidence to verify the.4, pregnancy, menopause, death risk factors of cervical invasion may not be cancer of the uterus sarcoma patients, but the number of documents in the study were only 1 that argument strength is very small, may cause a great error in the results of statistical analysis, the results need more high quality, large sample research to provide reliable data for analysis.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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