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Abstract
Objective Lymph nodal involvement is a prognostic factor in endometrial cancer. The added value of para-aortic lymphadenectomy compared with pelvic nodal evaluation alone remains a matter of debate in the management of patients with intermediate- and high-risk endometrial cancer. A systematic review and meta-analysis was conducted to assess the prognostic value of para-aortic lymphadenectomy in terms of overall survival and disease-free survival in patients with intermediate- and high-risk endometrial cancer.
Methods The study adhered to the PRISMA guidelines. PubMed, Google Scholar and ClinicalTrials.gov were searched from January 2000 to April 2023. Studies on intermediate- and high-risk patients who underwent pelvic versus pelvic and para-aortic dissection were included in the analysis. The Methodological Index for Nonrandomized Studies (MINORS) and the Quality Assessment of Diagnostic Accuracy Studies 2 tool (QUADAS-2) were used for quality assessment of the selected articles.
Results Fourteen studies were identified, encompassing 9415 patients with a median age of 62 years (IQR 56.5–66.5). The majority had International Federation of Gynecology and Obstetrics stage I–II disease (76%) and endometrioid histology (89%). The 72% of patients who underwent only pelvic nodal evaluation and the 87% who underwent pelvic and para-aortic lymphadenectomy received adjuvant treatment (p=0.44). Pelvic and para-aortic lymphadenectomy was associated with a significant improvement in 5-year overall survival (RR=0.71, 95% CI 0.57 to 0.88, p<0.01), translating to a 41% reduction in the risk of overall death. However, no significant differences were observed in the 5-year risk of recurrence (RR=1.12, 95% CI 0.94 to 1.34, p=0.15). Additionally, patients undergoing pelvic and para-aortic lymphadenectomy experienced a 26% increased risk of post-operative complications (RR=1.26, 95% CI 1.04 to 1.53, p=0.03) and prolonged operative times (MD=56.27, 95% CI 15.94 to 96.60, p<0.01).
Conclusion Pelvic and para-aortic lymphadenectomy appears to confer a prognostic benefit in patients with intermediate- and high-risk endometrial cancer. Robust prospective studies are needed to further validate these findings and elucidate the precise role of para-aortic lymphadenectomy in the optimal management of these patients.
- Endometrial Neoplasms
- Lymph Nodes
- Lymphatic Metastasis
- Retroperitoneal Neoplasms
Data availability statement
In accordance with the journal guidelines, we will provide our data for independent analysis by a team selected by the Editorial Team for the purposes of additional data analysis or for the reproducibility of this study in other centers if such is requested.
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Data availability statement
In accordance with the journal guidelines, we will provide our data for independent analysis by a team selected by the Editorial Team for the purposes of additional data analysis or for the reproducibility of this study in other centers if such is requested.
Footnotes
Twitter @FlorianeJochum, @frafanfani
MP and FJ contributed equally.
Contributors MP, FJ, LL, and CA contributed to the study design. MP, FJ, and LL performed the literature research. MP, FJ, and DQ wrote the first draft. FJ was responsible for the statistical analysis. FF, GS, DQ, and CA were responsible for the critical revision of the manuscript and for important intellectual content. DQ and CA were guarantor for the publication. All authors have read and commented on the previous version of the paper. All authors approved the final version of the paper before submission.
Funding This work was supported by French state funds managed within the Plan Investissements d’Avenir and by the ANR (reference ANR-10-IAHU-02).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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