| Objective:To study the related cases of Solitary Fibrous Tumor(SFT)of female reproductive system by means of meta-analysis,the clinical manifestations,diagnostic methods,pathological features,therapeutic modalities and prognosis of the disease are comprehensively analyzed and discussed,with a view to providing evidence-based basis for clinical work.Methods:Comprehensively search the literature on female reproductive system SFT published from the establishment of English databases such as Pubmed,Embase,Web of Science,and Chinese databases such as CNKI,Wanfang Data Knowledge Service Platform,China Biomedical Literature Database,and VIP Database from November2022.Moreover,literatures related to SFT of female reproductive system or retrospective clinical case analysis were selected and screened according to the inclusion criteria and exclusion criteria.Quality evaluation of the included literatures referred to MINORS scale.Individual patient data(IPD)were extracted from the final included literature,including age,disease course,family history,related disease history,tumor location,and clinical manifestations(symptoms and signs).Diagnostic methods: imaging examination and serological examination;pathological characteristics: Gross morphology,histopathological examination and immunohistochemical examination of specimens;Treatment,follow-up,and patient outcomes.Stata16 software was used for relevant statistical analysis: the ratio and 95%Confident Interval(CI)of the non-control binary count data were calculated,and the factors that might affect the recurrence of SFT were statistically analyzed.First,the single factor analysis was carried out: Age and tumor size were quantitative variables consistent with normal distribution.Independent sample t test was used for analysis.The mitotic image was tested by non-parametric test(Mann-Whitney test).Necrosis,incisal margin,tumor location,surgical method,and risk were analyzed by Fisher’s exact probability method.Tumor types were analyzed by continuous-corrected Chi-square test.Statistically significant influencing factors,such as incisal margin and tumor type,were included in the binary Logistic regression analysis model for analysis,and p < 0.05 was considered statistically significant.Results:The literature was searched according to the established literature search strategy,and the literature was screened according to inclusion criteria and exclusion criteria,and 65 patients from 61 case reports were finally included.A total of 52 cases of SFT were included,10 cases of malignant solitary fibrous tumor(MSFT),2 cases of dedifferentiated SFT and 1 case of borderline SFT.MSFT and dedifferentiated SFT accounted for 18.46%(12/65).1.The onset age of female reproductive SFT ranges from 14 to 81 years old,with an average age of 50.03 years old and a median age of 50 years old.2.The course of SFT of female reproductive system ranged from 0.25 to 180months(excluding one patient with acute onset),with an average onset time of 39.15 months and a median duration of 12 months.3.Among the cases with reported clinical symptoms,vulvar swelling/mass was the most common,accounting for about 32.08%(17/53),with a 95%CI of [20.67,45.37].Pelvic/lower abdominal pain accounted for 22.64%(12/53),and 95%CI was[12.98,35.19].Irregular vaginal bleeding(increased menstruation,decreased menstruation,postmenopausal vaginal bleeding,etc.)accounted for about 20.75%(11/53),and its 95%CI was [11.50,33.10].About 20.75%(11/53)were asymptomatic,and 95%CI was [11.50,33.10].Compression symptoms(defecation,dysuria,urinary retention,etc.)accounted for 13.21%(7/53),and 95%CI was [6.05,24.26].Hypoglycemia accounted for 5.66%(3/53),and its 95%CI was [1.52,14.45].Dyspnea and infertility were 3.77%(2/53),and 95%CI was [0.68,11.69].Increased vaginal secretions and weight loss accounted for 1.89%(1/53),and 95%CI was [0.10,08.65].4.Among the cases with reported clinical signs,the painless/mild tender mass accounted for 26.00%(13/50),and the 95%CI was [15.38,39.29].Both mobile/mobile mass and hard mass accounted for 24.00%(12/50),and 95%CI was[13.79,37.11].Touching mass(not specifically described)accounted for 18.00%(9/50),and its 95%CI was [9.25,30.35].The proportion of poorly fixed/mobile masses and well-defined masses was about 16.00%(8/50),and the 95%CI was [7.80,27.99].Uterine enlargement accounted for 12.00%(6/50),and 95%CI was [5.09,23.15].The mass in the mass was about 8.00%(4/50),and the 95%CI was [2.67,18.03].Soft mass,tenderness/tenderness mass and uterine/cervical displacement accounted for about 6.00%(3/50),and 95%CI was [1.60,15.27].Both polypoid mass and elastic mass accounted for 4.00%(2/50),and 95%CI was [0.72,12.38].Vegetable mass,vulvar edema tension pain,cervical hypertrophy,tough mass,adjunctive thickening and pleural effusion all accounted for about 2.00%(1/50),and 95%CI was[0.11,9.13].5.33 cases,15 cases and 23 cases of ultrasonography,MRI and CT were reported,respectively,with a diagnosis rate of 0%.The features and manifestations of MRI and CT were more detailed than those of ultrasound.3 Routine PET/CT examination,abnormal rate: 66.67%(2/3);Chest CT/ X-ray examination was performed in 4 cases,among which 2 cases indicated lung abnormalities,with an abnormal rate of 50.00%(2/4).6.27 Serological examination was performed before surgery,and 3 cases showed abnormalities,with a positive rate of 11.11%(3/27).Abnormal tumor markers were CA199,HE4,CA125 and CA172.7.Immunohistochemical results: The positive rates of CD34,STAT6,Ki-67 and Vimentin were 100%(63/63,17/17,28/28,30/30).The positive rate of CD99 was87.18%(34/39),and the 95%CI was 74.07,95.03.The positive rate of BCl-2 was93.33%(42/45),and 95%CI was [83.13,98.21].The positive rate of ER was 32.00%(8/25),and 95%CI was [12.3,51.7].The positive rate of PR was 42.86%(9/21),and95%CI was [19.8,65.9].The positive rate of desmin was 7.14%(3/42),and the95%CI was [1.92,17.99].The positive rate of S100 was 2.08%(1/48),and 95%CI was[0.11,9.51].The positive rate of AE1/AE3 was 6.67%(1/15),and 95%CI was [0.38,27.50].The positive rate of CD10 was 44.44%(8/18),and the 95%CI was 19.0,69.9.The positive rate of SMA was 12.24%(6/49),and the 95%CI was [5.20,23.58].The positive rate of P53 was 66.67%(4/6),and its 95%CI was [28.35,92.97].The positive rate of CK was 14.29%(14.29),and 95%CI was [3.97,33.62].The positive rate of CD117 was 10.53%(2/19),and the 95%CI was [1.96,29.94].The positive rate of HMB-45 was 9.09%(1/11),and 95%CI was [0.55,35.62].The positive rates of CD68 and calmodulin were 25.00%(1/4),and 95%CI was [1.84,71.94].8.Among the 65 patients included,common complications included uterine leiomyoma 11.76%(2/17),infertility 11.76%(2/17),and breast cancer history 11.76%(2/17).Family history was described in 8 cases,none of which showed significant abnormalities.9.Among the 65 patients included,all 65 patients received surgical treatment,and the follow-up time was 1-90 months.During the follow-up period,a total of 2patients died,accounting for 4.17%(2/48)of all the follow-up cases.During the follow-up period,37 cases had no recurrence and 11 cases relapsed,with a recurrence rate of 22.92%(11/48).The shortest follow-up time of death cases was 4 months and the longest was 5 months.The shortest follow-up time of recurrent cases was 1 month and the longest was 43 months.10.Analysis of the factors influencing recurrence: age(P=0.369),mitotic image(P=0.053),necrosis(P=0.107),tumor size(P=0.662),incisal margin(P=0.023),tumor location(P=0.108),surgical method: Vulva and vagina group(P=0.314),cervix and uterus group(P=0.176),broad ligament and pelvis group(P=0.259),risk stratification(P=0.243),tumor type(P=0.003).Statistically significant factors,such as resection margin and tumor type,were included in the binary Logistic regression analysis model for analysis(resection margin: P=0.064 OR=-2.989 B =0.050 95%CI[0.002,1.190];Tumor type: P=0.376 OR=-1.539 B =0.215 95%CI[0.007,6.492]),neither of which was an independent risk factor for recurrence of SFT.Conclusions:1.The common symptoms of SFT in the female reproductive system are local swelling or mass,and the common signs are painless/mild tender mass.MRI and CT imaging features are more detailed than ultrasound,but preoperative diagnosis of SFT based on imaging is still very difficult,and serological examination has little effect on the diagnosis of SFT.2.The diagnosis of SFT in female reproductive system depends on histopathological and immunohistochemical examination.The combined detection of multiple immunohistochemical markers(CD99,CD34,BCl-2,STAT6,ER,Ki-67,PR,CD10,P53,Vimentin,etc.)can assist in the definitive diagnosis.3.Female reproductive system is prone to recurrence of SFT.Positive incisal margin and tumor type are influencing factors of SFT recurrence. |
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