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. 2024 Oct 8;2(1):76.
doi: 10.1038/s44276-024-00084-4.

Survival benefit of cytoreductive surgery in patients with primary stage IV endometrial cancer: a systematic review & meta-analysis

Eveline Ngoc Bao Pham  1 , Nanda Horeweg  2 , Jacolien van der Marel  3 , Linda Suzanne Nooij  4
Affiliations

Survival benefit of cytoreductive surgery in patients with primary stage IV endometrial cancer: a systematic review & meta-analysis

Eveline Ngoc Bao Pham et al. BJC Rep. .

Abstract

Background: This systematic review and meta-analysis aimed to investigate the survival outcomes following cytoreductive surgery (CRS) in patients with primary stage IV endometrial cancer (EC).

Methods: We systematically searched the Cochrane Library, Embase, MEDLINE/PubMed, and Web of Science for original studies reporting survival outcomes of primary stage IV EC after complete, optimal, and incomplete CRS. Pooled hazard ratios (HRs) for overall survival (OS) comparing optimal CRS with incomplete CRS were calculated using a random-effects model. Heterogeneity was assessed using the I2 and the Q-test.

Results: Twelve studies, including 748 patients, were analysed. 187 patients underwent complete CRS, and 146 patients optimal CRS. Ten studies reported a significant OS benefit after complete (18-48 months) and optimal CRS (13-34 months) compared to incomplete CRS (7-19 months). A benefit was also observed in patients with serous EC or extra- abdominal metastasis. Meta-analysis showed improved OS after complete/optimal vs. incomplete CRS (HR = 0.38, 95% CI 0.21-0.69, p = 0.0016). Heterogeneity was substantial between studies (I2 = 76.7%, p < 0.0001).

Conclusion: Our study supports considering CRS in all patients with primary stage IV EC if complete resection is deemed feasible, while also emphasizing the importance of weighing the harms and benefits of this extensive treatment and adopting shared decision-making.

Prospero registration: CRD42022302968 on May 10th, 2022.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Overview of study selection for the systematic review and meta-analysis.
Definition of abbreviation: EC endometrial carcinoma.
Fig. 2
Fig. 2. Forest plot of the meta-analysis comparing complete and optimal CRS vs incomplete CRS.
I cohort = patients with intra-abdominal metastasis only, E cohort = patients with extra-abdominal metastasis. Definition of abbreviations: HR hazard ratio, CRS = cytoreductive surgery.
Fig. 3
Fig. 3. Funnel plot of the hazard ratio of complete/optimal CRS vs incomplete CRS by the standard error of the HR to assess publication bias.
The studies are represented by dots. The dashed vertical line represents the pooled HR. Substantial asymmetry of the studies compared to the line of the pooled estimate is observed. The test for funnel plot asymmetry is significant and confirms the presence of publication bias. Definition of abbreviation: CRS cytoreductive surgery.
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