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

Abstract

ObjectiveFew 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.MethodsEMBASE 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.ResultsTwo 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<0.05) with low cross-study heterogeneity (p=0.29 and I2=17.8), favoring the AH group. However, this pattern was not observed in the subgroup analysis for the randomized trials. There was no evidence of publication bias.ConclusionIn this meta-analysis, AH following chemoradiotherapy did not improve survival in patients with LACC, although it seemed to reduce the risk of recurrence. Concerning the significant morbidity of AH after chemoradiotherapy, routine use of AH should be avoided.

Long noncoding RNA ZNF667‐AS1 reduces tumor invasion and metastasis in cervical cancer by counteracting microRNA‐93‐3p‐dependent PEG3 downregulation

“…Hysterectomy is one of the most widely adopted therapeutic approaches for managing patients with early‐stage CC, along with concurrent radiation and chemotherapy (Johansen et al , ; Ross Green et al , ). However, majority of CC treatment protocols confer to a poor prognosis in patients, particularly in those who underwent hysterectomy (Shim et al , ). The molecular underpinnings of CC are not yet well elucidated.…”

Propensity score-matched analysis of systemic chemotherapy versus salvage hysterectomy for persistent cervical cancer after definitive radiotherapy/concurrent chemoradiotherapy.

“…For example, salvage HT is a treatment speci cally for patients in whom tumors persist after de nitive RT/CCRT, whereas completion HT/adjuvant HT can be given to all patients who undergo de nitive RT/CCRT. A meta-analysis has shown that completion HT/adjuvant HT is not superior to conventional surveillance with regard to survival bene t [25]. Therefore, the selection of HT after de nitive RT/CCRT requires a careful patient selection strategy in order for it to be an effective treatment modality.…”

“…Our study is the rst to take the treatment intensity of RT into account when evaluating the e cacy of surgical treatment for cervical cancer after de nitive RT. Indeed, previous studies, including prospective trials or meta-analysis, did not contain details of RT intensity [20][21][22][23][24][25][27][28], which might preclude the adoption of salvage HT after de nitive RT/CCRT in the clinic. In the current study, the median dose of EQD2 in the HT cohort was 68.1 Gy, and this dose would ensure that RT/CCRT leads to a complete cure.…”

Propensity score-matched analysis of systemic chemotherapy versus salvage hysterectomy for persistent cervical cancer after definitive radiotherapy/concurrent chemoradiotherapy.

“…Our study is the rst to take the treatment intensity of RT into account when evaluating the e cacy of surgical treatment for cervical cancer after de nitive RT. Indeed, previous studies, including prospective trials or meta-analysis, did not contain details of RT intensity [20][21][22], which might preclude the adoption of salvage HT after de nitive RT/CCRT in the clinic. In the current study, the median dose of EQD2 in the HT cohort was 68.1 Gy, and this dose would ensure that RT/CCRT leads to a complete cure.…”