Impact of adjuvant hysterectomy on prognosis in patients with locally advanced cervical cancer treated with concurrent chemoradiotherapy: a meta-analysis

• Published in: Journal of gynecologic oncology 2018, 29(2), , pp.1-18
• Main Authors: Shim, Seung Hyuk, Kim, Soo Nyung, Chae, Su Hyun, Kim, Jung Eun, Lee, Sun Joo
• Format: Article
• Language: English
• Subjects: Chemoradiotherapy; Female; Humans; Hysterectomy - adverse effects; MEDLINE; Middle Aged; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - prevention & control; Neoplasm Staging; Odds Ratio; Original; Postoperative Complications - epidemiology; Prognosis; Randomized Controlled Trials as Topic; Survival Rate; Uterine Cervical Neoplasms - mortality; Uterine Cervical Neoplasms - therapy; 산부인과학
• ISSN: 2005-0380; 2005-0399
• DOI: 10.3802/jgo.2018.29.e25

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. 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. 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 I²=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