Surgical or imaging lymph node assessment in locally advanced cervical cancer: a systematic review and meta-analysis
- Author:
Ritchie DELARA
1
;
Jie YANG
;
Skye BUCKNER-PETTY
;
Paul MAGTIBAY
;
Kristina BUTLER
Author Information
- Publication Type:Original Article
- From:Journal of Gynecologic Oncology 2020;31(6):e79-
- CountryRepublic of Korea
- Language:English
-
Abstract:
Objective:To evaluate the survival impact of imaging vs surgical nodal assessment in patients with cervical cancer stage IB2–IVA prior to definitive chemoradiotherapy (CRT).
Methods:PubMed, MEDLINE, Cochrane Library, and ClinicalTrials.gov were used to search for publications in English and Chinese over a 50-year period. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols was used to conduct this review.Inclusion criteria were studies that compared survival outcomes in International Federation of Gynecology and Obstetrics 2009 stage IB2–IVA cervical cancer patients with pre-therapy pelvic and/or aortic lymphadenectomy (LND) or imaging. One or more of the following modalities were used for nodal assessment: computed tomography (CT), magnetic resonance imaging, or positron emission tomography-CT. The National Institutes of Health Quality Assessment Tool was utilized to assess study quality.
Results:The initial search identified 65 studies, and five met the inclusion criteria. There were a total of 1,112 patients. Seven hundred and fifty-four underwent pelvic and/or aortic LND and 358 had imaging. When compared to LND, imaging had a sensitivity and specificity of 88.9% and 22.2% for pelvic lymph node (LN), and 33%–62.5% and 92%–95.5% for para-aortic LN.There were no differences in progression-free survival (PFS) (hazard ratio [HR]=1.13; 95% confidence interval [CI]=0.73–1.74; I2 =75%; p<0.01) and overall survival (OS) (HR=1.06; 95% CI=0.66–1.69; I 2 =75%; p<0.01) between surgical and imaging nodal assessment.
Conclusions:Imaging and surgical nodal assessment has comparable PFS and OS in patients with cervical cancer stage IB2–IVA.
