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Prognostic significance of lymphadenectomy in uterine leiomyosarcomas and endometrial stromal sarcomas: Systematic review and meta-analysis

  • Yue Li
    Affiliations
    Department of Gynaecology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong Province, PR China
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  • Qing Gong
    Affiliations
    Department of Gastrointestinal Surgery, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong Province, PR China
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  • Jin Peng
    Affiliations
    Department of Gynaecology, Cheeloo Hospital, Shandong University, Cheeloo College of Medicine, Jinan, PR China
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  • Yan Liu
    Affiliations
    Department of Gynaecology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong Province, PR China
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  • Yameng Jiang
    Affiliations
    Department of Gynaecology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong Province, PR China
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  • Shihong Zhang
    Correspondence
    Corresponding author at: Department of Gynaecology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, No. 70 Heping Road, Weihai, Shandong Province 264200, PR China.
    Affiliations
    Department of Gynaecology, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong Province, PR China
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Published:October 21, 2022DOI:https://doi.org/10.1016/j.ejogrb.2022.10.013

      Highlights

      • Uterine leiomyosarcomas (uLMS) and endometrial stromal sarcomas (ESS) were studied.
      • The impact of lymphadenectomy on the prognosis of uLMS and ESS was evaluated.
      • Lymphadenectomy was found to have little effect in patients with early-stage uLMS or low-grade ESS.
      • Lymphadenectomy may show survival benefits in patients with high-grade ESS.

      Abstract

      The clinical value of lymph node dissection remains controversial. This study aimed to evaluate the impact of lymphadenectomy on the prognosis of patients with uterine leiomyosarcomas (uLMS) or endometrial stromal sarcomas (ESS). PubMed, EMBASE and the Cochrane Library were searched for studies describing the prognostic significance of lymphadenectomy in uLMS or ESS. Quality assessments were performed using the Newcastle–Ottawa Scale, relative hazard ratios and a random-effects model. Thirty-two retrospective cohort studies that included 26,693 patients in total were enrolled. Patients with uLMS or low-grade ESS (LG-ESS) had no survival benefits from lymphadenectomy. However, patients with high-grade ESS (HG-ESS), did show survival benefits of lymphadenectomy, with no heterogeneity. No significant evidence of publication bias was found. Lymphadenectomy had little prognostic effect on patients with early-stage uLMS or LG-ESS. The best treatment for HG-ESS is early, comprehensive hysterectomy with lymph node dissection.

      Keywords

      Abbreviations:

      CI (confidence interval), ESS (endometrial stromal sarcoma), HG (high-grade), LG (low-grade), LMS (leiomyosarcoma), MMMT (malignant mixed Mullerian tumor), NOS (Newcastle-Ottawa), OS (overall survival), RR (relative risk), uLMS (uterine leiomyosarcoma)
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