Impact of Radical Hysterectomy Versus Simple Hysterectomy on Survival of Patients with Stage 2 Endometrial Cancer: A Meta-analysis

• Published in: Annals of surgical oncology 2019-09, Vol.26 (9), p.2933-2942
• Main Authors: Liu, Ting, Tu, Hua, Li, Yongxue, Liu, Zhimin, Liu, Guochen, Gu, Haifeng
• Format: Article
• Language: English
• Subjects: Endometrial cancer; Endometrial Neoplasms - mortality; Endometrial Neoplasms - pathology; Endometrial Neoplasms - surgery; Endometrium; Female; Gynecologic Oncology; GYNECOLOGY; HAZARDS; Humans; Hysterectomy; Hysterectomy - classification; Hysterectomy - mortality; Medicine; Medicine & Public Health; Meta-analysis; Neoplasm Staging; NEOPLASMS; Obstetrics; Oncology; PATIENTS; Radiation therapy; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; Retrospective Studies; SURGERY; Surgical Oncology; Survival; Survival Rate; Systematic review; Systematic Reviews as Topic
• ISSN: 1068-9265; 1534-4681; 1534-4681
• DOI: 10.1245/s10434-019-07472-y

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.