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. 2021 Sep;11(9):4125-4136.
doi: 10.21037/qims-20-1331.

Uterine artery embolization, surgery and high intensity focused ultrasound in the treatment of uterine fibroids: a network meta-analysis

Haijun Gao  1 , Tianping Li  2 , Dianxun Fu  3 , Jun Wei  4
Affiliations

Uterine artery embolization, surgery and high intensity focused ultrasound in the treatment of uterine fibroids: a network meta-analysis

Haijun Gao et al. Quant Imaging Med Surg. 2021 Sep.

Abstract

Background: To systematic review the safety and effectiveness between uterine artery embolization (UAE), surgery and high intensity focused ultrasound (HIFU) in the treatment of uterine fibroids.

Methods: The PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang Data, and CNKI were electronically searched to collect relevant studies on comparing the safety and effectiveness of UAE, surgery and HIFU in the treatment of uterine fibroids from January 2000 to August 2019. After two reviewers independently screened the literature, extracted the data and evaluated the risk of bias of included studies, network meta-analysis was performed by ADDIS 1.16.8 and Stata 14 software.

Results: A total of 11 studies (22 articles) involving 3,646 patients were included. Compared with surgery, UAE and HIFU patients had higher quality of life (1-year follow-up) improvement, and UAE was higher than HIFU. Network meta-analysis show that patients treated with HIFU had the lowest incidence of major complications within 1 year, followed by UAE, and the highest surgery. Patients treated with HIFU and UAE have shorter hospital stays and quicker recovery time than surgery. The rate of further intervention after surgery treatment might be lower than that of UAE and HIFU.

Conclusions: UAE has the highest quality of life improvement (1-year follow-up) for uterine fibroids. HIFU and UAE are safer with shorter hospital stays and quicker recovery time compared with surgery. However, both UAE and HIFU have the risks of re-treatment. However, limited by the number and quality of included studies, the above conclusions need to be verified through more high-quality studies.

Keywords: Uterine fibroids; high intensity focused ultrasound (HIFU); network meta-analysis; surgery; uterine artery embolization (UAE).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/qims-20-1331). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
PubMed search strategy.
Figure 2
Figure 2
PRISMA flow diagram. *, PubMed (n=1,490), Embase (n=441), Web of Science (n=226), The Cochrane Library (n=18), CNKI (n=20), Wanfang data (n=15).
Figure 3
Figure 3
Direct comparison of three treatment methods. UAE, uterine artery embolization; HIFU, high intensity focused ultrasound.
Figure 4
Figure 4
The sequence of treatment methods in different outcomes. (A) Major complications; (B) hospital stay; (C) recovery time; (D) further intervention rate after treatment. UAE, uterine artery embolization; HIFU, high intensity focused ultrasound.
Figure 5
Figure 5
Funnel plots of objective cure rate with 11 RCTs. U: uterine artery embolization; S: surgery; H: high intensity focused ultrasound. RCTs, randomized controlled trials.
See this image and copyright information in PMC

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