The Effect Of Ovarian Transposition For The Ovarian Function In Premenopausal Women With Cervical Carcinoma：a Meta-analysis

ObjectiveTo evaluate the effectiveness and safety of ovarian transposition (OT) in premeno-pausal women with cervical carcinoma.MethodsThe databases such as PubMed, EMbase, The Cochrane Library, CNKI, CBM, etc.were electronically searched，from their inception to Dec.2013.We also searched relevantre-ferences of included articles and relevant reviews. We set up three control groups(Group A: radiotherapy with or without OT; Group B: OT followed by radiotherapy ornot; Group C: pure OT versus pure reserved ovaries in situ).Two reviewers independ-ently screen-ed the trials, extracted the data, and assessed the methodology quality.Meta-analysis was performed by using RevMan5.2software.Results17articles were included,including five trials for group A (96/68patients), nine tria-ls for groupB (241/241patients) and six trials for groupC (445/446patients).The results ofMeta-analysis showed:(1) GroupA:Compared with reserved ovari es in situ, OT before radiotherapy cansignificantly improve the clinical effectiveness (RR=24.38,95%CI6.69to88.91), serumestrogen (MD=143.36,95%CI70.22to216.51), and reduce serum follicle stimulatinghormone(FSH)(MD=-75.45,95%CI-118.12to-32.77) after radiotherapy.(2) Group B:Compared with the OT without radiotherapy,OT followed by radiother-apy had lower clinical sign effect [RR=0.74,95%CI (0.58,0.94)], lower serum estrogen[MD=94.44,95%CI(166.37,22.52)],but higher serum FSH [MD=8.20,95%CI (1.41,14.99)]. (3) Group C: Compared with pure reserved ovaries in situ, except in the1st monthpost operation, patients with pure OT had significantly higher serum FSH and lowerserum estrogen. There was no statistical significant difference in Clinical effective rate[RR=0.96,95%CI (0.90,1.03)], serum sex hormone levels in the3rd and6th monthpost operation between the two groups. The difference of serum FSH in the1st,3rd and6th month post operation were MD=11.40,95%CI (4.45,18.35), MD=3.78,95%CI(-0.21,7.78) and MD=0.67,95%CI (0.13,1.47), respectively. The difference of serumestrogen in the1st,3rd and6th month post operation were MD=58.16,95%CI (106.19,10.13), MD=49.69,95%CI (-113.86,14.48) and MD=21.64,95%CI (58.29,15.01),respectively.(4) Because the description of the postoperative complications in literatures wereunclear or the rate of two groups were0%, it was hard to program Meta-analysis.But theoriginal data showed that the most common postoperative complications of OT was ovar-ian cyst, the rate of ovarian metastasis was low and the rate of recurrence did notincreased because of OT.ConclusionsMeta-analysis show that ovarian transposition are effective to protect the ovarianfunction in premenopausal patients treated with radiotherapy for early cervical cancer.But ovarian transposition can not entirely avoid radiation injury. Ovarian function isimpaired in one months after OT,and slowly began to recover after3months. Still,large,well–designed，multicenter controlled trials are needed before producing best-practice recommendations on this topic.