A Meta-Analysis Of Factors Influencing Recurrence After Radical Cervical Cancer Resection

Objective:To systematically evaluate the influencing factors related to postoperative recurrence of cervical cancer,providing statistical basis for guiding clinical prevention of postoperative recurrence of cervical cancer,and helping to extend the overall survival period of patients.Methods:Excel software was used to extract and record literature materials,publicly published studies on risk factors related to postoperative recurrence of cervical cancer in CNKI,Wanfang database,VIP database,and Pub Med were searched through computer.The search was conducted from the establishment of the database to December 2022,and the included literature was screened,evaluated,extracted,analyzed,and concluded.Screening was conducted based on inclusion and exclusion criteria,and meta-analysis was conducted using the "Review Manager5.3" software to analyze the effects of lymph node metastasis,differentiation,tumor size,clinical stage,infiltration depth,pathological classification,postoperative SCC-Ag status,preoperative neoadjuvant chemotherapy,postoperative HRHPV status,presence of vascular cancer thrombi,open surgery or laparoscopy,postoperative radiotherapy and chemotherapy,and age on postoperative recurrence of cervical cancer after radical surgery.Use odds ratio(OR)and 95% confidence interval(CI)as the effect measures;Use I2 to test for heterogeneity.When I2 ≤ 50% and P>0.1,it indicates homogeneity,and a fixed effect model(FEM)is used.When I2 is greater than50% and P is less than 0.1,it indicates significant heterogeneity.Sensitivity analysis is conducted using a piece by piece exclusion method to explore studies that have a significant impact on the total merge effect.If the results of the total merge effect are stable and sufficient literature is included,further subgroup analysis is conducted to identify the source of heterogeneity.If heterogeneity is still significant,a Random Effects Model(REM)is used for meta-analysis.The meta-analysis results are represented by forest maps.When more than 10 articles were included,publication bias analysis was conducted.Results:Finally,According to the standard,a total of 10 articles were included in the study,with a total of 4926 patients,of which 748 had recurrence and 4178 had no recurrence.Comprehensive analysis shows that in long-term management data,postoperative recurrence of cervical cancer is associated with the following factors: lymph node metastasis [OR(95% CI): 3.36,(2.16-5.24),P<0.00001];Degree of low differentiation[OR(95% CI): 3.12,(2.02-4.81),P<0.00001];Tumor size ≥ 4cm [OR(95% CI): 1.88(1.35-2.63),P=0.0002];Tumor staging ≥ Phase II [OR(95% CI): 3.10(2.10-4.57),P<0.00001];Infiltration depth ≥ 1/2 of the muscle layer [OR(95% CI): 3.03(1.97-4.66),P<0.00001];Pathological classification is adenocarcinoma [OR(95% CI): 1.73(1.16-2.58),P=0.007];Postoperative SCC-Ag positivity [OR(95% CI): 11.80(6.92-20.13),P<0.00001];Postoperative HR-HPV positivity [OR(95% CI): 18.69(10.11-34.53),P<0.00001];Vascular cancer thrombus [OR(95% CI): 8.92(3.34-23.85),P<0.0001].Preoperative neoadjuvant chemotherapy has a certain protective effect on postoperative recurrence of cervical cancer [OR(95% CI): 0.20(0.10-0.38),P<0.00001].However,the impact of factors such as open surgery or laparoscopy [OR(95% CI): 1.49(0.96-2.33),P=0.08],postoperative radiotherapy and chemotherapy [OR(95% CI): 0.94(0.65-1.36),P=0.75],and age [OR(95% CI): 1.02(0.70-1.49),P=0.90] on postoperative recurrence of cervical cancer was not statistically significant.Conclusion:The risk factors related to postoperative recurrence of cervical cancer include lymph node metastasis,low differentiation,tumor size ≥ 4cm,tumor stage ≥ Phase Ⅱ,invasion depth ≥ 1/2 of the muscle layer,pathological classification as adenocarcinoma,postoperative SCC-Ag positive,postoperative HR-HPV positive,and presence of vascular cancer thrombi.Preoperative neoadjuvant chemotherapy is a protective factor for postoperative recurrence of cervical cancer.Age,laparotomy or laparoscopy,and the presence or absence of postoperative radiotherapy and chemotherapy may not be associated with postoperative recurrence of cervical cancer.