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. 2022 Mar 1:9:843262.
doi: 10.3389/fmed.2022.843262. eCollection 2022.

Survival of Patients With Cervical Cancer Treated With Definitive Radiotherapy or Concurrent Chemoradiotherapy According to Histological Subtype: A Systematic Review and Meta-Analysis

Guorong Yao  1 , Jian Qiu  1 , Fengjia Zhu  1 , Xiaoxie Wang  1
Affiliations

Survival of Patients With Cervical Cancer Treated With Definitive Radiotherapy or Concurrent Chemoradiotherapy According to Histological Subtype: A Systematic Review and Meta-Analysis

Guorong Yao et al. Front Med (Lausanne). .

Abstract

Background: Cervical cancer is a leading cause of morbidity and mortality for women worldwide. Different histopathological cervical cancer subtypes (i.e., adenocarcinoma/adenosquamous carcinoma, and squamous cell carcinoma) are all treated similarly with definitive radiotherapy or concurrent chemoradiotherapy, but studies have reported differing survival prognoses. In this review and meta-analysis, we compared the disease-free and overall survivals of patients with cervical cancer treated with definitive radiotherapy or concurrent chemoradiotherapy according to the histopathological subtypes.

Objective: To compare the disease-free and overall survivals of patients with adenocarcinoma/adenosquamous carcinoma and squamous cell carcinoma cervical cancer treated with definitive radiotherapy or concurrent chemoradiotherapy.

Methods: We systematically searched the Web of Science, EMBASE, CENTRAL, Scopus, and MEDLINE academic databases following PRISMA guidelines. We identified publications to conduct a random-effects meta-analysis to evaluate the disease-free and overall survivals of patients with cervical adenocarcinoma/adenosquamous carcinoma and squamous cell carcinoma treated with definitive radiotherapy or concurrent chemoradiotherapy.

Results: From 963 studies, we found eight eligible ones with 13,859 patients with cervical cancer (mean age, 52.2 ± 7.9 years). Our meta-analysis revealed a poorer outcome of disease-free (hazard ratio, 1.51; 95% CI, 1.28-1.79) and overall (hazard ratio 1.41; 95% CI, 1.26-1.57) survivals for patients with adenocarcinoma/adenosquamous carcinoma undergoing definitive radiotherapy or concurrent chemoradiotherapy than for those with squamous cell carcinoma undergoing similar treatments. We also observed that larger tumor size and advanced tumor stage are also significant prognostic factors that adversely impact survival outcomes in cervical cancer patients undergoing definitive radiotherapy or concurrent chemoradiotherapy.

Conclusion: Our results show poor disease-free and overall survivals for patients with cervical cancer and adenocarcinoma/adenosquamous carcinoma than for those with squamous cell carcinoma after treatment with definitive radiotherapy or concurrent chemoradiotherapy. Our findings clarify the risks associated with the conventional management of cervical cancer according to the histological type.

Keywords: cervical cancer survival cervical cancer; chemotherapy; disease-free survival; overall survival; radiotherapy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart.
Figure 2
Figure 2
Risk of bias according to the Newcastle Ottawa scale for cohort studies.
Figure 3
Figure 3
Publication bias by Duval and Tweedy's trim and fill method.
Figure 4
Figure 4
Forest plot for studies evaluating the disease-free survival in patients with adenocarcinoma/adenosquamous carcinoma or squamous cell carcinoma.
Figure 5
Figure 5
Forest plot for studies evaluating the disease-free survival in patients with differential tumor size.
Figure 6
Figure 6
Forest plot for studies evaluating the disease-free survival in patients with differential tumor stage.
Figure 7
Figure 7
Forest plot for studies evaluating the overall survival in patients with adenocarcinoma/adenosquamous carcinoma or squamous cell carcinoma.
Figure 8
Figure 8
Forest plot for studies evaluating the overall survival in patients with differential tumor size.
Figure 9
Figure 9
Forest plot for studies evaluating the overall survival in patients with differential tumor stage.
See this image and copyright information in PMC

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