Background/Objectives: The objective of this systematic review and meta-analysis was to compare the risk of recurrence and residual disease between conservative and demolitive treatment in patients diagnosed with cervical adenocarcinoma in situ (AIS). Methods: Bibliographic databases (CENTRAL, PubMed, Cochrane Database of Systematic Reviews, and Google Scholar) were searched for studies published up to December 2024 reporting both conservative and demolitive treatment outcomes. Exclusion criteria were the lack of outcomes of interest, the reporting of only one treatment modality, and a lack of follow-up. The ROBINS-I tool was used to assess the risk of bias. The evaluated outcomes were AIS or invasive recurrence and AIS or invasive residual after margin positivity at the first excision. A meta-analysis with a fixed-effect model and the Mantel–Haenszel method for risk ratio (RR) with a 95% confidence interval (CI) was performed. Heterogeneity was evaluated with the chi-squared test and quantified with the I2 method. A meta-regression was performed using the year of publication, CKC use, margin positivity, and follow-up duration as predictors. Results: Nineteen studies were included, reporting data about 5934 patients with AIS diagnosis after conization. The meta-analysis showed a higher risk of recurrence as AIS in conservatively treated patients (11 studies, RR = 8.44, 95% CI 3.36–21.19,p< 0.001, I2 = 0.0%,p= 0.73), while no differences were observed in the risk of recurrence as invasive adenocarcinoma (10 studies, RR = 1.67, 95% CI 0.82–3.39,p= 0.16, I2 = 0.00%,p= 0.48). No difference between the two treatment modalities in terms of AIS residual (nine studies, RR = 0.89, 95% CI 0.62–1.26,p= 0.50, I2 = 33%,p= 0.15) or invasive residual (three studies, RR = 0.48, 95% CI 0.09–2.41,p= 0.37, I2 = 0.0%,p= 0.94) after margin positivity at the first excision emerged. The meta-regression showed no association with the predictors. Conclusions: The safety profile of a conservative treatment for AIS patients seems not to differ from that of a demolitive approach in terms of invasive recurrence or residual, while it seems to be associated with a higher risk of AIS recurrence. Future research should focus on optimizing follow-up strategies to detect AIS recurrences early.
背景/目的：本系统综述与荟萃分析旨在比较宫颈原位腺癌（AIS）患者接受保守治疗与根治性治疗在复发风险和残留病灶方面的差异。方法：检索截至2024年12月收录于书目数据库（CENTRAL、PubMed、Cochrane系统综述数据库及Google Scholar）中同时报告保守与根治性治疗结局的研究。排除标准包括：缺乏目标结局数据、仅报告单一治疗方式、缺乏随访数据。采用ROBINS-I工具评估偏倚风险。评估结局包括：AIS或浸润性复发，以及首次切除切缘阳性后的AIS或浸润性残留病灶。采用固定效应模型和Mantel-Haenszel法计算风险比（RR）及95%置信区间（CI）进行荟萃分析。通过卡方检验评估异质性，并采用I²方法量化异质性程度。以发表年份、宫颈锥切术使用情况、切缘阳性状态及随访时长作为预测因子进行元回归分析。结果：共纳入19项研究，涉及5934例锥切术后确诊AIS的患者。荟萃分析显示，保守治疗患者的AIS复发风险更高（11项研究，RR=8.44，95% CI 3.36–21.19，p<0.001，I²=0.0%，p=0.73），而浸润性腺癌复发风险无显著差异（10项研究，RR=1.67，95% CI 0.82–3.39，p=0.16，I²=0.00%，p=0.48）。在首次切除切缘阳性后，两种治疗方式在AIS残留（9项研究，RR=0.89，95% CI 0.62–1.26，p=0.50，I²=33%，p=0.15）或浸润性残留（3项研究，RR=0.48，95% CI 0.09–2.41，p=0.37，I²=0.0%，p=0.94）方面均无显著差异。元回归分析显示各预测因子与结局无显著关联。结论：对于AIS患者，保守治疗在浸润性复发或残留病灶方面的安全性特征与根治性治疗无显著差异，但似乎与更高的AIS复发风险相关。未来研究应着重优化随访策略以实现AIS复发的早期监测。
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