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Survival benefits of pelvic lymphadenectomy versus pelvic and para-aortic lymphadenectomy in patients with endometrial cancer: A meta-analysis.

Abstract Despite that pelvic and para-aortic lymphadenectomy (PPaLND) is recommended as part of accurate surgical staging by International Federation of Gynecology and Obstetrics (FIGO) in endometrial cancer, the impact of para-aortic lymphadenectomy on survival remains controversial. The aim of this work is to evaluate the survival benefits or risks in endometrial cancer patients who underwent surgical staging with or without para-aortic lymphadenectomy using meta-analysis.
PMID
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Authors

Mayor MeshTerms

Lymph Node Excision

Keywords
Journal Title medicine
Publication Year Start




PMID- 29505525
OWN - NLM
STAT- MEDLINE
DCOM- 20180309
LR  - 20180309
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 1
DP  - 2018 Jan
TI  - Survival benefits of pelvic lymphadenectomy versus pelvic and para-aortic
      lymphadenectomy in patients with endometrial cancer: A meta-analysis.
PG  - e9520
LID - 10.1097/MD.0000000000009520 [doi]
AB  - BACKGROUND: Despite that pelvic and para-aortic lymphadenectomy (PPaLND) is
      recommended as part of accurate surgical staging by International Federation of
      Gynecology and Obstetrics (FIGO) in endometrial cancer, the impact of para-aortic
      lymphadenectomy on survival remains controversial. The aim of this work is to
      evaluate the survival benefits or risks in endometrial cancer patients who
      underwent surgical staging with or without para-aortic lymphadenectomy using
      meta-analysis. METHODS: Literature search was undertaken using PubMed, Embase,
      and Cochrane Library databases for relevant articles published between January 1,
      1990, and January 1, 2017, without language restriction. The primary outcome was 
      overall survival (OS); progression-free survival (PFS)/recurrence-free survival
      (RFS)/disease-free survival (DFS)/disease-related survival (DRS) was also
      analyzed. Subgroup analysis and sensitivity analysis were conducted to
      investigate the source of heterogeneity. Quality assessments were performed by
      Newcastle-Ottawa Quality Assessment Scale (NOS). Publication bias was evaluated
      by using Begg and Egger tests. The hazard ratio (HR) was pooled with
      random-effects or fixed-effects model as appropriate. RESULTS: Eight studies with
      a total of 2793 patients were included. OS was significantly longer in PPaLND
      group than in pelvic lymphadenectomy (PLND) group for patients with endometrial
      cancer [HR 0.68; 95% confidence interval (CI) 0.55-0.84, P < .001, I = 12.2%].
      Subgroup analysis by recurrence risk explored the same association in patients at
      intermediate- or high-risk (HR 0.52; 95% CI 0.39-0.69, P < .001, I = 41.4%), but 
      not for low-risk patients (HR 0.48; 95% CI 0.21-1.08, P = .077, I = 0). PPaLND
      with systematic resection of all para-aortic nodes up to renal vein also improved
      PFS/RFS/DFS/DRS, compared with PLND (HR 0.52, 95% CI 0.37-0.72, P < .001, I = 0).
      No publication bias was observed among included studies. CONCLUSION: PPaLND is
      associated with favorable survival outcomes in endometrial cancer patients with
      intermediate- or high-risk of recurrence compared with PLND, particularly with
      regards to OS. PPaLND with systematic resection of all para-aortic nodes up to
      renal vein also improve PFS compared with PLND. Further large-scale randomized
      clinical trials are required to validate our findings.
CI  - Copyright (c) 2017 The Authors. Published by Wolters Kluwer Health, Inc. All
      rights reserved.
FAU - Guo, Weina
AU  - Guo W
AD  - Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, 
      Huazhong University of Science and Technology, Wuhan, China.
FAU - Cai, Jing
AU  - Cai J
FAU - Li, Min
AU  - Li M
FAU - Wang, Hongbo
AU  - Wang H
FAU - Shen, Yi
AU  - Shen Y
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Carcinoma/mortality/*surgery
MH  - Endometrial Neoplasms/mortality/*surgery
MH  - Female
MH  - Humans
MH  - *Lymph Node Excision
MH  - Pelvis/surgery
EDAT- 2018/03/06 06:00
MHDA- 2018/03/10 06:00
CRDT- 2018/03/06 06:00
PHST- 2018/03/06 06:00 [entrez]
PHST- 2018/03/06 06:00 [pubmed]
PHST- 2018/03/10 06:00 [medline]
AID - 10.1097/MD.0000000000009520 [doi]
AID - 00005792-201801050-00022 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 Jan;97(1):e9520. doi: 10.1097/MD.0000000000009520.