Adjuvant therapy de-escalation for stage I uterine leiomyosarcoma: A systematic review and meta-analysis

IF 4.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY Gynecologic oncology Pub Date : 2024-10-23 DOI:10.1016/j.ygyno.2024.10.018

Yoshikazu Nagase , Koji Matsuo , Yumi Nakao , Tsuyoshi Hisa , Shoji Kamiura , Takeshi Yokoi , Lynda D. Roman , Jason D. Wright , Shinya Matsuzaki

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Abstract

Objective

To examine the association between adjuvant chemotherapy and survival outcomes in patients with stage I uterine leiomyosarcoma (uLMS).

Methods

This comprehensive systematic review and meta-analysis through December 31, 2023 (PROSPERO registration number: CRD42024504776) investigated studies that examined survival outcomes in patients with stage I uLMS using 4 public search engines (PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials). Two investigators searched the studies independently, and survival outcomes (overall survival [OS] and disease-free survival [DFS]) were compared between the adjuvant chemotherapy and observation groups. Utilization rate of adjuvant chemotherapy and the regimens used were also assessed. Kaplan-Meier survival curves in the two treatment groups were evaluated using ImageJ software.

Results

From 1988 to 2022, 16 eligible studies including a total of 5690 patients met the inclusion criteria and evaluated the effect of adjuvant chemotherapy on survival outcomes in patients with stage I uLMS. Adjuvant chemotherapy was utilized in 38.5 % of patients (range, 14.8 % to 70.0 %). Eight studies from 2017 to 2022 compared the survival outcomes between adjuvant chemotherapy and observation. OS was comparable between the two groups in both unadjusted (n = 6, hazard ratio [HR] 1.02, 95 % confidence interval [CI] 0.77–1.35, P = 0.88) and adjusted (n = 4, HR 0.90, 95 %CI 0.56–1.43, P = 0.65) pooled analyses. DFS was also similar between adjuvant chemotherapy and observation in both unadjusted (n = 4, HR 0.78, 95 %CI 0.53–1.13, P = 0.18) and adjusted (n = 2, HR 1.14, 95 %CI 0.67–1.94, P = 0.64) pooled analyses. Adjuvant chemotherapy regimens utilized included doxorubicin, ifosfamide, cisplatin, gemcitabine, and docetaxel as monotherapies or combination therapies.

Conclusions

In this contemporaneous systematic review and meta-analysis, less than 40 % of patients received adjuvant chemotherapy for stage I uLMS and adjuvant chemotherapy which was not associated with improved survival. These results support the current National Comprehensive Cancer Network clinical practice guidelines that recommends de-escalating adjuvant chemotherapy in stage I uLMS after complete resection.

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I期子宫良性肌瘤的辅助治疗降级：系统回顾和荟萃分析。

目的探讨辅助化疗与 I 期子宫肌层肉瘤（uLMS）患者生存结果之间的关系：这项全面的系统综述和荟萃分析截至 2023 年 12 月 31 日（PROSPERO 注册号：CRD42024504776），使用 4 个公共搜索引擎（PubMed、Scopus、Web of Science 和 Cochrane Central Register of Controlled Trials）调查了有关 I 期子宫良性肉瘤患者生存结果的研究。两名研究者独立检索了这些研究，并比较了辅助化疗组和观察组的生存结果（总生存期[OS]和无病生存期[DFS]）。此外，还对辅助化疗的使用率和使用的方案进行了评估。使用 ImageJ 软件评估了两个治疗组的 Kaplan-Meier 生存曲线：从1988年到2022年，共有16项符合纳入标准的研究，包括5690名患者，评估了辅助化疗对I期uLMS患者生存结果的影响。38.5%的患者采用了辅助化疗（范围为14.8%至70.0%）。2017年至2022年的8项研究比较了辅助化疗和观察的生存结果。在未调整（n = 6，危险比[HR] 1.02，95 %置信区间[CI] 0.77-1.35，P = 0.88）和调整（n = 4，HR 0.90，95 %CI 0.56-1.43，P = 0.65）汇总分析中，两组患者的OS相当。在未调整（n = 4，HR 0.78，95 %CI 0.53-1.13，P = 0.18）和调整（n = 2，HR 1.14，95 %CI 0.67-1.94，P = 0.64）的汇总分析中，辅助化疗和观察的 DFS 也相似。采用的辅助化疗方案包括多柔比星、伊福法胺、顺铂、吉西他滨和多西他赛，作为单一疗法或联合疗法：在这项同期系统综述和荟萃分析中，不到40%的I期尿路肿瘤患者接受了辅助化疗，而辅助化疗与生存率的提高无关。这些结果支持美国国家综合癌症网络（National Comprehensive Cancer Network）目前的临床实践指南，该指南建议I期尿路肿瘤患者在完全切除后不再进行辅助化疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Gynecologic oncology 医学-妇产科学

CiteScore

8.60

自引率

6.40%

发文量

1062

审稿时长

37 days

期刊介绍： Gynecologic Oncology, an international journal, is devoted to the publication of clinical and investigative articles that concern tumors of the female reproductive tract. Investigations relating to the etiology, diagnosis, and treatment of female cancers, as well as research from any of the disciplines related to this field of interest, are published. Research Areas Include: • Cell and molecular biology • Chemotherapy • Cytology • Endocrinology • Epidemiology • Genetics • Gynecologic surgery • Immunology • Pathology • Radiotherapy