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. 2022 Apr;10(7):409.
doi: 10.21037/atm-22-928.

Ovarian protection and safety of gonadotropin-releasing hormone agonist after cervical cancer surgery: systematic review and meta-analysis

Jialing Yuan  1   2 , Yi Lai  1   2 , Tao Li  1   2
Affiliations

Ovarian protection and safety of gonadotropin-releasing hormone agonist after cervical cancer surgery: systematic review and meta-analysis

Jialing Yuan et al. Ann Transl Med. 2022 Apr.

Abstract

Background: This meta-analysis was performed using Stata (15.0), and sought to systematically evaluate the domestic application value of the gonadotropin-releasing hormone agonist (GNRH-a) after cervical cancer, and explore its protective effect on the ovaries during chemotherapy. In many studies, the effectiveness and safety of GNRH-a are not consistent, and there is great controversy. Therefore, it is very important to systematically evaluate the protection and safety of GNRH-a after cervical cancer surgery.

Methods: PubMed, Cochrane Library, and Web of Science databases were systematically searched to retrieve articles on domestic trials examining the use of GNRH-a treatment in cervical cancer patients, published from January 2014 to January 2021, which were reviewed according to the inclusion and exclusion criteria of this study. The meta-analysis of the included study data was conducted using Stata 15.0.

Results: In total, 10 articles were included in the meta-analysis, comprising 579 ovarian-reserved cervical cancer subjects, all of whom received 4-6 standardized courses of PC (Paclitaxel + Cisplatin) chemotherapy. The following statistically significant differences were found: bovine follicle stimulating hormone [odds ratio (OR) =1.82, 95% confidence interval (CI): 1.38-2.38; P<0.0001], bovine estrogen 2 (OR =2.39, 95% CI: 1.69-3.37; P<0.00001), anti-Mullerian hormone (OR =2.39, 95% CI: 1.71-3.34; P<0.00001), and bovine antral follicle count (OR =2.11, 95% CI: 1.49-2.99; P<0.0001); but there is no statistically significant difference incidence of coincidences (OR =0.80, 95% CI: 0.49-1.31; P=0.38).

Conclusions: The use of GNRH-a in cervical cancer patients receiving the PC chemotherapy regimen plays a significant role in protecting ovarian function.

Keywords: Gonadotropin-releasing hormone agonist (GNRH-a); cervical cancer; meta-analysis; ovarian protection; systematic review.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://atm.amegroups.com/article/view/10.21037/atm-22-928/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow chart of the article screening process.
Figure 2
Figure 2
Literature quality evaluation chart. (A) Risk of bias graph; (B) risk of bias summary. +, low risk of bias; −, high risk of bias; ?, unclear risk of bias.
Figure 3
Figure 3
Funnel plots of literature publication bias. OR, odds ratio; SE, standard error.
Figure 4
Figure 4
Meta-analysis comparing bFSH levels between the two groups. bFSH, bovine follicle stimulating hormone; OR, odds ratio; +, low risk of bias; −, high risk of bias; ?, unclear risk of bias.
Figure 5
Figure 5
Meta-analysis comparing bE2 levels between two groups. bE2, bovine estrogen 2; OR, odds ratio; +, low risk of bias; −, high risk of bias; ?, unclear risk of bias.
Figure 6
Figure 6
Meta-analysis comparing AMH levels between two groups. AMH, anti-Mullerian hormone; OR, odds ratio; +, low risk of bias; −, high risk of bias; ?, unclear risk of bias.
Figure 7
Figure 7
Meta-analysis comparing bAFC levels between two groups. bAFC, bovine antral follicle count; OR, odds ratio; +, low risk of bias; −, high risk of bias; ?, unclear risk of bias.
Figure 8
Figure 8
Meta-analysis of incidence of coincidences between two groups. OR, odds ratio; +, low risk of bias; −, high risk of bias; ?, unclear risk of bias.
See this image and copyright information in PMC

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