Impact of adjuvant hysterectomy on prognosis in patients with locally advanced cervical cancer treated with concurrent chemoradiotherapy: a meta-analysis
Impact of adjuvant hysterectomy on prognosis in patients with locally advanced cervical cancer treated with concurrent chemoradiotherapy: a meta-analysis
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DOI：
10.3802/jgo.2018.29.e25
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发表时间：
2018-03-01
影响因子：
3.9
通讯作者：
Lee, Sun Joo
中科院分区：
文献类型：
--
作者：
Shim, Seung-Hyuk;Kim, Soo-Nyung;Lee, Sun Joo
目的：关于接受放化疗的局部晚期宫颈癌 (LACC) 患者辅助子宫切除术 (AH) 的数据很少。我们通过荟萃分析研究了 AH 对 LACC 患者预后的影响。方法：检索 EMBASE 和 MEDLINE 数据库以及 Cochrane 图书馆已发表的研究，比较截至 2016 年 4 月放化疗后接受 AH 的 LACC 患者与未接受 AH 的患者。终点为死亡率和复发率。为了汇总评估 AH 对死亡率/复发率的影响，使用了随机或固定效应荟萃分析模型。结果：两项随机试验和六项观察性研究（放化疗后的 AH，630 名患者；放化疗，585 名患者）符合我们的搜索标准。基于固定效应模型的荟萃分析表明，各组之间的死亡率没有显着差异（比值比 [OR]=1.01；95% 置信区间 [CI]=0.58-1.78；p=0.968），且交叉研究异质性较低（p=0.73 和 I-2=0.0）。在研究设计、放射类型、放化疗后的反应和子宫切除类型的亚组分析中观察到了这种模式。 AH 和复发的汇总 OR 为 0.59（95% CI=0.44-0.79；p
Objective: Few data exist regarding adjuvant hysterectomy (AH) in locally advanced cervical cancer (LACC) patients treated with chemoradiotherapy. We investigated the effect of AH on prognosis in LACC patients, through meta-analysis.Methods: EMBASE and MEDLINE databases and the Cochrane Library were searched for published studies comparing LACC patients who received AH after chemoradiotherapy with those who did not, through April 2016. Endpoints were mortality and recurrence rates. For pooled estimates of the effect of AH on mortality/recurrence, random-or fixed-effects meta-analytical models were used.Results: Two randomized trials and six observational studies (AH following chemoradiotherapy, 630 patients; chemoradiotherapy, 585 patients) met our search criteria. Fixed-effects model-based meta-analysis indicated no significant difference in mortality between the groups (odds ratio [ OR]=1.01; 95% confidence interval [ CI]=0.58-1.78; p=0.968) with low cross-study heterogeneity (p=0.73 and I-2=0.0). This pattern was observed in subgroup analysis for study design, radiation type, response after chemoradiotherapy, and hysterectomy type. The pooled OR for AH and recurrence was 0.59 (95% CI=0.44-0.79; p