Abstract
Objective: To compare the incidence of ovarian metastasis (OM) in early stage adenocarcinoma (AC) and squamous cell carcinoma (SCC) of the cervix, evaluate the overall survival with ovarian preservation and determine risk factors of OM for early stage AC. Data sources, methods of study selection: We searched the Cochranes database, Embase, and PubMed for publications to November 2020. The articles reporting the incidence, risk factors and overall survival of OM in AC were included. Articles that lacked sufficient data of the odds ratios (ORs) and 95% confidence intervals (CIs) were excluded. A fixed effects model was used to calculate OR and 95% CIs. Eggers test and Funnel plot were used to test the publication bias. Forest plots was used to present and synthesise results. Tabulation, integration and results: In the meta-analysis, the incidence of OM of AC was higher than that of SCC (OR 5.68, 95% CI 4.40–7.32, I2 = 28.1%) in stage IA-IIB. The incidence of OM was 0% in stage IA, 2.72% in stage IB, 5.95% in stage IIA, and 12.86% in stage IIB AC. Ovarian preservation was not significantly associated with OS (OR 0.53, 95% CI 0.35–0.80, I2 = 37.8%) in early stage of AC. We found seven risk factors for OM: deep stromal invasion (OR 8.80, 95% CI 3.20–24.23, I2 = 0%), corpus uteri invasion (OR 6.29, 95% CI 3.36–11.77, I2 = 21.8%), tumor size >>4 cm (OR 3.78, 95% CI 1.86–7.69, I2 = 30.5%), FIGO stage IIA (OR 3.67, 95% CI 1.98–6.81, I2 = 0%), FIGO stage IIB (OR 4.31, 95% CI 2.74–6.77, I2 = 0%), FIGO stage II (OR 3.99, 95% CI 2.49–6.41, I2 = 0%) and lympho-vascular space invasion (OR 2.90, 95% CI 1.36–6.17, I2 = 0%). Conclusions: Ovarian preservation is only recommended in stage IA and stage IB AC without risk factors, but not reasonable for stage IIA and IIB AC. Both stage IIA and IIB are risk factors for OM in early stage AC.
Highlights
Secondary to the increase in early screening, the incidence of cervical squamous cell carcinoma (SCC) has decreased while the incidence of cervical adenocarcinoma (AC) is increasing [1,2]
We found seven risk factors for ovarian metastasis (OM): deep stromal invasion, corpus uteri invasion, tumor size >4 cm, FIGO stage IIA, FIGO stage IIB, FIGO stage II and lympho-vascular space invasion
Ovarian preservation is only recommended in stage IA and stage IB AC without risk factors, but not reasonable for stage IIA and IIB AC
Summary
Secondary to the increase in early screening, the incidence of cervical squamous cell carcinoma (SCC) has decreased while the incidence of cervical adenocarcinoma (AC) is increasing [1,2]. Some studies have found that the incidence of ovarian metastasis (OM) for AC was higher than that for SCC by 4.5%–7.8% [4–10], but some studies reported that the incidence of OM in early AC and SCC were similar [11]. It is still controversial whether young patients with early AC should have ovarian preservation. We identified the difference in the incidence of early AC and SCC and the overall survival (OS) of ovarian preservation for early AC through meta-analysis. We identified the risk factors of OM in early AC
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