Ting Liu1, Hua Tu2, Yongxue Li3, Zhimin Liu2, Guochen Liu2, Haifeng Gu4. 1. Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China. 2. Department of Gynecologic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China. 3. Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China. 4. Department of Gynecologic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, China. guhf@sysucc.org.cn.
Abstract
BACKGROUND: The strategy of radical surgery for stage 2 endometrial cancer (EC) remains controversial. This meta-analysis aimed to investigate the impact of radical hysterectomy (RH) versus simple hysterectomy (SH) on survival of patients with stage 2 EC. METHODS: A systematic review was conducted to identify studies comparing survival between RH and SH in International Federation of Gynecology and Obstetrics (FIGO) stage 2 EC patients by searching several databases to July 2018. Hazard ratios (HRs) with 95% confidence intervals (CIs) for overall survival and progression-free survival were pooled using Stata V.12.0. RESULTS: The study included 10 retrospective cohort studies enrolling 2866 patients. Patients who received RH did not show a significant survival benefit for either overall survival (pooled HR 0.92; 95% CI 0.72-1.16; P = 0.484) or progression-free survival (pooled HR 0.75; 95% CI 0.39-1.42; P = 0.378). The result remained consistent after it was balanced with possible impact from adjuvant radiotherapy (pooled HR 0.85; 95% CI 0.62-1.16; P = 0.300). In earlier studies that staged patients according to FIGO 1988, RH showed a 27% survival benefit (pooled HR 0.73; 95% CI 0.53-1.00; P = 0.050), whereas in newly published studies based on FIGO 2009 staging, it reversely showed increased risk of death (pooled HR 1.24; 95% CI 0.86-1.77; P = 0.245). However, no statistical significance was reached under either staging criterion. CONCLUSIONS: Based on the results of this meta-analysis, RH does not significantly improve survival in stage 2 EC. The choice of RH remains controversial and should be considered carefully in clinical practice. More qualified studies are needed to determine the best treatment strategy for stage 2 EC.
BACKGROUND: The strategy of radical surgery for stage 2 endometrial cancer (EC) remains controversial. This meta-analysis aimed to investigate the impact of radical hysterectomy (RH) versus simple hysterectomy (SH) on survival of patients with stage 2 EC. METHODS: A systematic review was conducted to identify studies comparing survival between RH and SH in International Federation of Gynecology and Obstetrics (FIGO) stage 2 EC patients by searching several databases to July 2018. Hazard ratios (HRs) with 95% confidence intervals (CIs) for overall survival and progression-free survival were pooled using Stata V.12.0. RESULTS: The study included 10 retrospective cohort studies enrolling 2866 patients. Patients who received RH did not show a significant survival benefit for either overall survival (pooled HR 0.92; 95% CI 0.72-1.16; P = 0.484) or progression-free survival (pooled HR 0.75; 95% CI 0.39-1.42; P = 0.378). The result remained consistent after it was balanced with possible impact from adjuvant radiotherapy (pooled HR 0.85; 95% CI 0.62-1.16; P = 0.300). In earlier studies that staged patients according to FIGO 1988, RH showed a 27% survival benefit (pooled HR 0.73; 95% CI 0.53-1.00; P = 0.050), whereas in newly published studies based on FIGO 2009 staging, it reversely showed increased risk of death (pooled HR 1.24; 95% CI 0.86-1.77; P = 0.245). However, no statistical significance was reached under either staging criterion. CONCLUSIONS: Based on the results of this meta-analysis, RH does not significantly improve survival in stage 2 EC. The choice of RH remains controversial and should be considered carefully in clinical practice. More qualified studies are needed to determine the best treatment strategy for stage 2 EC.
Authors: Salim Abraham Barquet-Muñoz; David Cantú-de-León; Antonio Bandala-Jacques; Aarón González-Enciso; David Isla-Ortiz; Diddier Prada; Luis A Herrera; R A Salcedo-Hernández Journal: World J Surg Oncol Date: 2020-05-21 Impact factor: 2.754