Unit of Gynecologic Oncology, Service of Gynecology, Vall d'Hebron Barcelona Hospital Campus, Autonoma University of Barcelona, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
Gynecology Department, Virgen de la Victoria University Hospital, Málaga, Spain.
Clin Transl Oncol. 2022 Aug;24(8):1605-1614. doi: 10.1007/s12094-022-02808-9. Epub 2022 Apr 19.
There is a gap in knowledge regarding the ideal management of patients with early-stage cervical cancer and intermediate-risk features. Here, we present a meta-analysis of the published literature on oncological outcomes in these patients and determine trends in postoperative management.
MEDLINE and PubMed were used for literature searches. The inclusion criteria were: English language articles including ≥ 10 patients, patients who underwent radical hysterectomy, nodes negative, studies reporting oncological outcomes and complications treatment-related and compare a surgery-only cohort with a radiotherapy cohort. The PRISMA guidelines were followed. Combined relative risk was calculated using DerSimonian-Laird random-effects model and a forest plot was drawn.
We collected 183 manuscripts on early-stage cervical cancer treated with radical hysterectomy alone or with adjuvant radiotherapy after surgery. A total of eight studies met the inclusion criteria. Regarding oncological outcomes, survival was reported in five studies. The relative risk of recurrence and the relative risk of mortality was similar in both groups independently whether receive or not adjuvant therapy. Most of the studies did not report significant differences regarding morbidity treatment related between the groups, except for a higher rate of lymphedema after radiotherapy.
We found that the relative risk of recurrence and mortality was similar in both groups not depending on adjuvant therapy. Therefore, whether radiotherapy adjuvant treatment is indicated remains a topic of debate.
对于早期宫颈癌且具有中危特征的患者，其理想的管理方法尚存在知识空白。本研究对这些患者的肿瘤学结局相关已发表文献进行了荟萃分析，并确定了术后管理的趋势。
使用 MEDLINE 和 PubMed 进行文献检索。纳入标准为：纳入≥ 10 例患者的英文文献、行根治性子宫切除术的患者、淋巴结阴性、报告肿瘤学结局和并发症治疗相关的研究，并比较单纯手术组和放疗组。遵循 PRISMA 指南。使用 DerSimonian-Laird 随机效应模型计算合并相对风险，并绘制森林图。
我们收集了 183 篇关于早期宫颈癌的文章，这些文章均采用根治性子宫切除术单独治疗或术后辅助放疗。共有 8 项研究符合纳入标准。关于肿瘤学结局，5 项研究报告了生存率。是否接受辅助治疗，两组的复发相对风险和死亡相对风险均相似。除了放疗后淋巴水肿发生率较高外，大多数研究并未报告两组间与治疗相关的发病率存在显著差异。
我们发现两组的复发和死亡相对风险相似，而这与辅助治疗无关。因此，是否需要辅助放疗仍然存在争议。
