GnRH-a对国内宫颈癌术后卵巢保护作用Meta分析
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摘要
目的使用Stata 15.0进行Meta分析,系统评价国内应用促性腺激素释放激素激动剂(Gn RH-a)在保留卵巢的宫颈癌根治术后的应用价值,探讨其对化疗过程中卵巢的保护作用。方法系统检索CNKI中国知网、维普及万方等数据库,按照本研究设定的纳入和排除标准,收集国内2014年1月-2019年1月公开发表关于宫颈癌保留卵巢后行辅助化疗时应用Gn RH-a治疗的随机对照研究,使用Stata 15.0对纳入研究资料进行Meta分析。结果共纳入4篇中中文文献,共计579名保留卵巢的宫颈癌术后受试者,均规范化行4～6个疗程的TP方案化疗,患者b FSH、b E2、AMH、b AFC分析结果为b FSH [SMD=-3.01,95%CI(-3.34,-2.67),P <0.001]、b E2 [SMD=-8.9,95%CI(-1.13,-0.65),P <0.001]、AMH [SMD=-1.17,95%CI(-0.41,-1.35-1.92),P <0.001]、b AFC [SMD=-1.2,95%CI(-2.07,-0.33),P <0.001],差异有统计学意义。结论在应用宫颈癌的化疗中配合促性腺激素释放激素激动剂,对TP化疗方案后患者的卵巢功能起到显著的保护作用。
Objective To evaluate the application value of gonadotropin-releasing hormone agonist(GnRH-a) after radical resection of cervical cancer with ovarian preservation by Meta-analysis with Stata 15.0. To explore its protective effect on ovaries during chemotherapy. Methods A systematic search of CNKI,Vepsa, Wan Fang and other databases was carried out according to the inclusion and exclusion criteria set in this study. A randomized controlled study was conducted in China from January 2014 to January 2019. A randomized controlled study of GnRH-a therapy for cervical cancer with ovarian preservation after adjuvant chemotherapy was conducted. The inclusion data were analyzed by Meta with Stata 15.0. Results A total of 579 patients with cervical cancer after operation were enrolled in 4 Chinese literatures. All patients were standardized for 4 ～ 6 courses of TP regimen chemotherapy, and the patients were treated with bFSH, bE2, AMH and bAFC. The results of bAFC analysis were as follows. bFSH [SMD =-3.01, 95% CI(-3.34,-2.67), P < 0.001], bE2 [SMD =-8.9, 95% CI(-1.13,-0.65), P < 0.001)], AMH [SMD =-1.17, 95% CI(-0.41,-1.35-1.92), P < 0.001], bAFC [SMD =-1.2, 95% CI(-2.07,-0.33), P < 0.001)], and bAFC [SMD =-1.2, 95% CI(-2.07,-0.33), P < 0.001]. The difference was statistically significant. Conclusion Combined with gonadotropin-releasing hormone agonist in the chemotherapy of cervical cancer, it can significantly protect the ovarian function of patients after TP chemotherapy.
Objective To evaluate the application value of gonadotropin-releasing hormone agonist(GnRH-a) after radical resection of cervical cancer with ovarian preservation by Meta-analysis with Stata 15.0. To explore its protective effect on ovaries during chemotherapy. Methods A systematic search of CNKI,Vepsa, Wan Fang and other databases was carried out according to the inclusion and exclusion criteria set in this study. A randomized controlled study was conducted in China from January 2014 to January 2019. A randomized controlled study of GnRH-a therapy for cervical cancer with ovarian preservation after adjuvant chemotherapy was conducted. The inclusion data were analyzed by Meta with Stata 15.0. Results A total of 579 patients with cervical cancer after operation were enrolled in 4 Chinese literatures. All patients were standardized for 4 ～ 6 courses of TP regimen chemotherapy, and the patients were treated with bFSH, bE2, AMH and bAFC. The results of bAFC analysis were as follows. bFSH [SMD =-3.01, 95% CI(-3.34,-2.67), P < 0.001], bE2 [SMD =-8.9, 95% CI(-1.13,-0.65), P < 0.001)], AMH [SMD =-1.17, 95% CI(-0.41,-1.35-1.92), P < 0.001], bAFC [SMD =-1.2, 95% CI(-2.07,-0.33), P < 0.001)], and bAFC [SMD =-1.2, 95% CI(-2.07,-0.33), P < 0.001]. The difference was statistically significant. Conclusion Combined with gonadotropin-releasing hormone agonist in the chemotherapy of cervical cancer, it can significantly protect the ovarian function of patients after TP chemotherapy.
引文
[1]陈慧.腹腔镜手术联合促性腺激素释放激素激动剂治疗卵巢巧克力囊肿的疗效及对卵巢功能的影响[J].现代中西医结合杂志,2015,24(20):2214-2216.
[2]彭萍,杨冬梓,郑澄宇,等.促性腺激素释放激素激动剂在化疗患者卵巢功能保护中应用的研究进展[J].中华妇产科杂志,2006,41(2):139-141.
[3]BANSAL A,PATEL F D,RAI B,et al.Gonadotrophin releasing hormone analogues for ovarian function preservation in young females undergoinng chemotherapy[J].Asian Pac JCancer Prev,2014,15(5):2185-2190.
[4]杜昌宇.促性腺激素释放激素激动剂对宫颈癌术后辅助化疗患者卵巢功能的保护作用[J].临床医药文献电子杂志,2018,5(65):73,76.
[5]万妮娅.促性腺激素释放激素激动剂对早期宫颈癌行保留卵巢根治术患者的作用[J].检验医学与临床,2018,15(7):934-935,939.
[6]李会荣,张同美.促性腺激素释放激素激动剂对早期宫颈癌行保留卵巢根治术患者卵巢功能的保护作用[J].海南医学,2018,29(2):181-183.
[7]张萍,薛秀华,李锦行.促性腺激素释放激素激动剂对宫颈癌术后辅助化疗患者卵巢功能的保护作用[J].山东医药,2015,55(34):36-37.
[8]SONG G,GAO H,YUAN Z.Effect of leuprolide acetate on ovarian function after cyclophosphamide-doxorubicin-based chemotherapy inpremenopausal patients with breast cancer:results from a phase?randomized trial[J].Med Oncol,2013,30(3):1-8.
[9]BANSAL A,PATEL F D,RAI B,et al.Gonadotrophin releasing hormone analogues for ovarian function preservation in young females undergoinng chemotherapy[J].Asian Pac JCancer Prev,2014,15(5):2185-2190.
[10]ELGINDY E A,ELHAIEG D O,KHORSHID O M,et al.Gonadatrophin suppression to prevent chemotherapyinduced ovarian damage:arandomized controlled trial[J].Obstet Gynecol,2013,121(1):78-86.
[11]WANG N,GUAN Q L,WANG K,et al.Radiochemotherapy versus radiotherapy in locally advanced cervical cancer:a meta-analysis[J].Arch Gynecol Obstet,2011,283(1):103-108.
[12]DEL M L,CEPPI M,POGGIO F,et al.Gonadotro-releasing hormone analogues for the prevention of chemotherapyinduced premature ovarian failure in cancer women:systematic review and metaanalysis of randomized trials[J].Cancer Treat Rev,2014,40(5):675-683.
[13]罗珊,李尚为,马黔红,等.长方案中短效促性腺激素释放激素激动剂使用时间对临床结局的影响[J].华西医学,2014,29(6):1082-1085.
[2]彭萍,杨冬梓,郑澄宇,等.促性腺激素释放激素激动剂在化疗患者卵巢功能保护中应用的研究进展[J].中华妇产科杂志,2006,41(2):139-141.
[3]BANSAL A,PATEL F D,RAI B,et al.Gonadotrophin releasing hormone analogues for ovarian function preservation in young females undergoinng chemotherapy[J].Asian Pac JCancer Prev,2014,15(5):2185-2190.
[4]杜昌宇.促性腺激素释放激素激动剂对宫颈癌术后辅助化疗患者卵巢功能的保护作用[J].临床医药文献电子杂志,2018,5(65):73,76.
[5]万妮娅.促性腺激素释放激素激动剂对早期宫颈癌行保留卵巢根治术患者的作用[J].检验医学与临床,2018,15(7):934-935,939.
[6]李会荣,张同美.促性腺激素释放激素激动剂对早期宫颈癌行保留卵巢根治术患者卵巢功能的保护作用[J].海南医学,2018,29(2):181-183.
[7]张萍,薛秀华,李锦行.促性腺激素释放激素激动剂对宫颈癌术后辅助化疗患者卵巢功能的保护作用[J].山东医药,2015,55(34):36-37.
[8]SONG G,GAO H,YUAN Z.Effect of leuprolide acetate on ovarian function after cyclophosphamide-doxorubicin-based chemotherapy inpremenopausal patients with breast cancer:results from a phase?randomized trial[J].Med Oncol,2013,30(3):1-8.
[9]BANSAL A,PATEL F D,RAI B,et al.Gonadotrophin releasing hormone analogues for ovarian function preservation in young females undergoinng chemotherapy[J].Asian Pac JCancer Prev,2014,15(5):2185-2190.
[10]ELGINDY E A,ELHAIEG D O,KHORSHID O M,et al.Gonadatrophin suppression to prevent chemotherapyinduced ovarian damage:arandomized controlled trial[J].Obstet Gynecol,2013,121(1):78-86.
[11]WANG N,GUAN Q L,WANG K,et al.Radiochemotherapy versus radiotherapy in locally advanced cervical cancer:a meta-analysis[J].Arch Gynecol Obstet,2011,283(1):103-108.
[12]DEL M L,CEPPI M,POGGIO F,et al.Gonadotro-releasing hormone analogues for the prevention of chemotherapyinduced premature ovarian failure in cancer women:systematic review and metaanalysis of randomized trials[J].Cancer Treat Rev,2014,40(5):675-683.
[13]罗珊,李尚为,马黔红,等.长方案中短效促性腺激素释放激素激动剂使用时间对临床结局的影响[J].华西医学,2014,29(6):1082-1085.