The incidence and risk factors for ovarian metastasis and overall survival with ovarian preservation for early-stage adenocarcinoma of the cervix-A meta-analysis

Objective: To compare the incidence of ovarian metastasis (OM) in early stage adenocarcinoma (AC) and squamous cell carcinoma (SCC) of the cervix, evaluate the overall survival with ovarian preservation and determine risk factors of OM for early stage AC. Data sources, methods of study selection: We searched the Cochranes database, Embase, and PubMed for publications to November 2020. The articles reporting the incidence, risk factors and overall survival of OM in AC were included. Articles that lacked sufficient data of the odds ratios (ORs) and 95% confidence intervals (CIs) were excluded. A fixed effects model was used to calculate OR and 95% CIs. Eggers test and Funnel plot were used to test the publication bias. Forest plots was used to present and synthesise results. Tabulation, integration and results: In the meta-analysis, the incidence of OM of AC was higher than that of SCC (OR 5.68, 95% CI 4.40–7.32, I = 28.1%) in stage IA-IIB. The incidence of OM was 0% in stage IA, 2.72% in stage IB, 5.95% in stage IIA, and 12.86% in stage IIB AC. Ovarian preservation was not significantly associated with OS (OR 0.53, 95% CI 0.35–0.80, I = 37.8%) in early stage of AC. We found seven risk factors for OM: deep stromal invasion (OR 8.80, 95% CI 3.20–24.23, I = 0%), corpus uteri invasion (OR 6.29, 95% CI 3.36–11.77, I = 21.8%), tumor size>4 cm (OR 3.78, 95% CI 1.86–7.69, I = 30.5%), FIGO stage IIA (OR 3.67, 95% CI 1.98–6.81, I = 0%), FIGO stage IIB (OR 4.31, 95% CI 2.74–6.77, I = 0%), FIGO stage II (OR 3.99, 95% CI 2.49–6.41, I = 0%) and lympho-vascular space invasion (OR 2.90, 95% CI 1.36–6.17, I = 0%). Conclusions: Ovarian preservation is only recommended in stage IA and stage IB AC without risk factors, but not reasonable for stage IIA and IIB AC. Both stage IIA and IIB are risk factors for OM in early stage AC.