Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan, China.
Ann Surg Oncol. 2024 Dec;31(13):8954-8960. doi: 10.1245/s10434-024-16326-1. Epub 2024 Oct 7.
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.
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.
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; I= 27.2%, p = 0.221), progression-free survival (PFS; HR 0.39, 95% CI 0.14-1.07; I= 0.0%, p = 0.625) and disease-free survival (DFS; HR 0.61, 95% CI 0.13-2.84; I= 0.0%, p = 0.574). Meta-analysis found the total recurrence (risk ratio [RR] 0.49, 95% CI 0.30-0.79; I= 0.0%, p = 0.810) and pelvic recurrence (RR 0.39, 95% CI 0.17-0.91; I= 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; I= 0.0%, p = 0.591).
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.
CRD42023480118.
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转而接受放化疗的临床结局，以期为临床治疗提供依据。
检索 PubMed、Embase、Cochrane 中央对照试验注册库（CENTRAL）、国际临床试验注册平台（ICTRP）和 ClinicalTrials.gov 数据库，检索时间从建库至 2023 年 11 月 20 日。采用 STATA 16.0 进行分析。
本综述共纳入 8 项研究，共 2105 例早期宫颈癌患者。Meta 分析结果显示，完成根治性子宫切除术（CRS）组与放弃根治性手术（ARS）组的总生存期（OS；风险比 [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）无显著差异。Meta 分析还发现，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）均低于 ARS 组。Meta 分析还发现，与 ARS 组相比，CRS 组的 3/4 级不良事件发生率更低（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转移的早期宫颈癌患者，CRS 和 ARS 的生存结局相似，但完成根治性手术可降低盆腔复发率。
CRD42023480118。
