The Prognostic Factors Of Small Cell Neuroendocrine Carcinoma Of The Uterine Cervix:A Meta-analysis

Objective:The Prognostic factors of small cell neuroendocrine carcinoma of the uterine cervix were analyzed by using systematic reviews method,which provided the theoretical basis for the clinical diagnosis and treatment.Research Methodology:The related cohort and case-control studies whose languages were limited to Chinese and English,about small cell neuroendocrine carcinoma of the uterine cervix were collected mainly by conducting a systematical search through both of the oversea and Chinese databases such as PubMed,EMbase,Cochrane Library,CNKI,and Wan Fang Database etc.before December,2018.Two researchers based on inclusion criteria and exclusion criteria performed independent review,evaluation and data extraction.RevMan5.3 software provided by Cochrane was used for meta-analysis.Research Results:The meta-analysis included total 12 literatures with 7 Chinese studies and 5studies in English.The Newcastle-Ottawa Scale was used to evaluate the quality of the literature,and all the literature scores were≥7 points.The meta-analysis showed that:1.There was no significant differences in 3-year survival rate and 5-year survival rate between age>40 and≤40 years old（P>0.05）;2.There was no significant differences in 5-year survival rate between FIGO stage<IB₁ and IB₂-IIB stage（P>0.05）,but the sensitivity analysis showed that the conclusion was in poor reliability and needed further verification;3.Tumor diameter（>4cm）had no significant effects on 5-year survival rate（P>0.05）;4.The histologic homology of tumors（pure or mixed）had no significant effects on both 3-year survival rate（P>0.05）and 5-year survival rate（P>0.05）.5.Depth of cervical stromal invasion>2/3significantly reduced the 5-year survival rate（OR=7.73,95%CI[1.37,43.56],P=0.02）.6.Lymph node metastasis had no significant effects on 2-year survival rate（P>0.05）and 3-year survival rate（P>0.05）,but significantly reduced 5-year survival rate with OR=0.37,95%CI[0.25,0.54],P<0.00001.7.Lymphovascular space invasion has significant effects on 3-year survival rate（OR=0.11,95%CI[0.02,0.50],P=0.004）and 5-year survival rate（OR=0.51,95%CI[0.27,0.96],P=0.04）,but the reliability of the conclusion of 3-year survival rate was poor.8.Surgical margin status（+）reduced 5-year survival rate（OR=0.27,95%CI[0.09,0.78],P=0.02）.9.NSE（+）had no significant effects on 2-year survival rate（P>0.05）.10.Neoadjuvant chemotherapy had no significant effects on 2-year survival rate（P>0.05）and 5-year survival rate（P>0.05）.11.The adjuvant chemotherapy had no significant effects on the 5-year survival rate（P>0.05）.12.Adjuvant radiotherapy had no significant effects on both 2-year survival rate（P>0.05）and 5-year survival rate（P>0.05）.Conclusion1.Neoadjuvant chemotherapy,adjuvant radiotherapy,NSE and lymph node metastasis had no effects on the short-term survival rate of patients with SNECC.2.Lymphovascular space invasion was an unfavorable factor for the mid-term survival of patients with SNECC,but the reliability of the conclusion was low and needed further verification.Age,histologic homology of tumors and lymph node metastasis had no effects on the mid-term survival rate of patients with SNECC.3.Depth of cervical stromal invasion（>2/3）,Surgical margin（+）,lymph node metastasis（+）,lymphovascular space invasion（+）were the long-term survival adverse factors of SNECC patients.Neoadjuvant chemotherapy,adjuvant chemotherapy,adjuvant radiotherapy,age,histologic homology of tumors and diameter of tumors had no effect on the long-term survival rate of patients with SNECC.FIGO stage（≤IB1 stage）was not a long-term prognostic factor in patients with SNECC,but the reliability of the conclusion was low,which needed further verification.