Clinical impact of low-volume lymph node metastases in early-stage cervical cancer: A comprehensive meta-analysis.
Adenocarcinoma
/ pathology
Carcinoma, Squamous Cell
/ pathology
Disease-Free Survival
Female
Humans
Lymph Nodes
/ pathology
Lymphatic Metastasis
Neoplasm Micrometastasis
/ pathology
Neoplasm Staging
Sentinel Lymph Node
/ pathology
Sentinel Lymph Node Biopsy
Survival Rate
Tumor Burden
Uterine Cervical Neoplasms
/ pathology
Cervical cancer
Low-volume lymph node metastasis
Sentinel lymph node
Ultrastaging
Journal
Gynecologic oncology
ISSN: 1095-6859
Titre abrégé: Gynecol Oncol
Pays: United States
ID NLM: 0365304
Informations de publication
Date de publication:
02 2022
02 2022
Historique:
received:
15
09
2021
revised:
01
12
2021
accepted:
10
12
2021
pubmed:
25
12
2021
medline:
23
2
2022
entrez:
24
12
2021
Statut:
ppublish
Résumé
In order to define the clinical significance of low-volume metastasis, a comprehensive meta-analysis of published data and individual data obtained from articles mentioning micrometastases (MIC) and isolated tumor cells (ITC) in cervical cancer was performed, with a follow up of at least 3 years. We performed a systematic literature review and meta-analysis, following Cochrane's review methods guide and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary outcome was the disease-free survival (DFS), and the secondary outcome was the overall survival (OS). The hazard ratio (HR) was taken as the measure of the association between the low-volume metastases (MIC+ITC and MIC alone) and DFS or OS; it quantified the hazard of an event in the MIC (+/- ITC) group compared to the hazard in node-negative (N0) patients. A random-effect meta-analysis model using the inverse variance method was selected for pooling. Forest plots were used to display the HRs and risk differences within individual trials and overall. Eleven articles were finally retained for the meta-analysis. In the analysis of DFS in patients with low-volume metastasis (MIC + ITC), the HR was increased to 2.60 (1.55-4.34) in the case of low-volume metastasis vs. N0. The presence of MICs had a negative prognostic impact, with an HR of 4.10 (2.71-6.20) compared to N0. Moreover, this impact was worse than that of MIC pooled with ITCs. Concerning OS, the meta-analysis shows an HR of 5.65 (2.81-11.39) in the case of low-volume metastases vs. N0. The presence of MICs alone had a negative effect, with an HR of 6.94 (2.56-18.81). In conclusion, the presence of MIC seems to be associated with a negative impact on both the DFS and OS and should be treated as MAC.
Identifiants
pubmed: 34949436
pii: S0090-8258(21)01672-3
doi: 10.1016/j.ygyno.2021.12.015
pii:
doi:
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
446-454Informations de copyright
Copyright © 2021. Published by Elsevier Inc.
Déclaration de conflit d'intérêts
Declaration of Competing Interest We declare no competing interests.