Clinical Outcomes Between Completion and Abandonment of Radical Hysterectomy in Early-Stage Cervical Cancer Patients with Lymph Nodal Involvement Identified During Surgery: A Systematic Review and Meta-Analysis.

IF 3.4 2区 医学 Q2 ONCOLOGY Annals of Surgical Oncology Pub Date : 2024-12-01 Epub Date: 2024-10-07 DOI:10.1245/s10434-024-16326-1
Hengxi Chen, Yali Chen, Ai Zheng, Xin Tan, Ling Han
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Abstract

Objective: This study aimed to summarize the clinical outcomes of early-stage cervical cancer patients with lymph node metastasis found during surgery who completed radical hysterectomy, or abandoned surgery and switched to chemoradiotherapy, in hopes of providing evidence for clinical treatment.

Methods: The PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), International Clinical Trials Registry Platform (ICTRP), and ClinicalTrials.gov databases were searched from inception to 20 November 2023. The analysis was conducted using STATA 16.0.

Results: A total of eight studies with 2105 early-stage cervical cancer patients were included in this review. Meta-analysis found no significant difference between the completing radical hysterectomy surgery (CRS) group and the abandoning radical surgery (ARS) group regarding overall survival (OS; hazard ratio [HR] 1.35, 95% confidence interval [CI] 0.93-1.97; I2 = 27.2%, p = 0.221), progression-free survival (PFS; HR 0.39, 95% CI 0.14-1.07; I2 = 0.0%, p = 0.625) and disease-free survival (DFS; HR 0.61, 95% CI 0.13-2.84; I2 = 0.0%, p = 0.574). Meta-analysis found the total recurrence (risk ratio [RR] 0.49, 95% CI 0.30-0.79; I2 = 0.0%, p = 0.810) and pelvic recurrence (RR 0.39, 95% CI 0.17-0.91; I2 = 12.4%, p = 0.320) in the CRS group were less than those in the ARS group. Meta-analysis found that compared with the ARS group, the CRS group had fewer grade 3/4 adverse effects (RR 0.58, 95% CI 0.41-0.82; I2 = 0.0%, p = 0.591).

Conclusions: Current evidence suggests that for early-stage cervical cancer patients with positive lymph nodes detected during surgery, CRS and ARS have similar survival outcomes, but completing radical surgery results in a lower incidence of pelvic recurrence.

Protocol registration: CRD42023480118.

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手术中发现淋巴结受累的早期宫颈癌患者完成和放弃根治性子宫切除术的临床结果:系统回顾与元分析》。
研究目的本研究旨在总结手术中发现淋巴结转移的早期宫颈癌患者完成根治性子宫切除术或放弃手术改用化放疗的临床疗效,希望为临床治疗提供证据:方法:对 PubMed、Embase、Cochrane 对照试验中央注册中心 (CENTRAL)、国际临床试验注册平台 (ICTRP) 和 ClinicalTrials.gov 数据库中从开始到 2023 年 11 月 20 日的数据进行了检索。分析使用 STATA 16.0 进行:本综述共纳入了 8 项研究,涉及 2105 名早期宫颈癌患者。Meta 分析发现,完成根治性子宫切除手术(CRS)组与放弃根治性手术(ARS)组在总生存率(OS;危险比 [HR] 1.35,95% 置信区间 [CI] 0.93-1.97;I2 = 27.2%,P = 0.221)、无进展生存期(PFS;HR 0.39,95% CI 0.14-1.07;I2 = 0.0%,P = 0.625)和无病生存期(DFS;HR 0.61,95% CI 0.13-2.84;I2 = 0.0%,P = 0.574)。Meta分析发现,CRS组的总复发率(风险比[RR] 0.49,95% CI 0.30-0.79;I2 = 0.0%,P = 0.810)和盆腔复发率(RR 0.39,95% CI 0.17-0.91;I2 = 12.4%,P = 0.320)低于ARS组。Meta 分析发现,与 ARS 组相比,CRS 组的 3/4 级不良反应较少(RR 0.58,95% CI 0.41-0.82;I2 = 0.0%,p = 0.591):目前的证据表明,对于手术中发现淋巴结阳性的早期宫颈癌患者,CRS和ARS具有相似的生存结果,但完成根治术后盆腔复发的发生率更低:CRD42023480118。
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来源期刊
CiteScore
5.90
自引率
10.80%
发文量
1698
审稿时长
2.8 months
期刊介绍: The Annals of Surgical Oncology is the official journal of The Society of Surgical Oncology and is published for the Society by Springer. The Annals publishes original and educational manuscripts about oncology for surgeons from all specialities in academic and community settings.
期刊最新文献
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