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Purpose <p>This meta-analysis aimed to evaluate the impact of lymphadenectomy (LND) on overall survival (OS) and progression-free survival (PFS) in intermediate- and high-risk early stage EC patients.</p> Methods <p>A systematic literature search was conducted across PubMed, ScienceDirect, Cochrane Library, EBSCOHost, ProQuest, and Google Scholar for articles published between February 27, 2000, and February 27, 2024. Studies were included if they compared outcomes between patients undergoing lymphadenectomy and those who did not, focusing on OS and PFS in intermediate- and high-risk groups. Data extraction and risk of bias assessments were performed independently by multiple reviewers following PRISMA guidelines. Meta-analyses using hazard ratios (HR) with 95% confidence intervals (CI) were conducted using Review Manager and MedCalc software. Heterogeneity, publication bias, and sensitivity analyses were also evaluated. The protocol was registered in PROSPERO (CRD42024574157).</p> Results <p>Seven studies encompassing 18,918 patients were included. LND was associated with a significant OS benefit in high-risk patients (HR 0.62, 95% CI 0.43–0.91), with less pronounced effects in intermediate-risk groups. No statistically significant PFS benefit was observed overall (HR 0.70, 95% CI 0.43–1.12), although subgroup analysis suggested improved outcomes for high-risk patients. Substantial heterogeneity was noted across studies, particularly in OS analyses. The pooled proportion of positive lymph nodes was higher in high-risk patients (20.91%) compared to intermediate-risk patients (8.42%). Publication bias was not detected, and sensitivity analysis confirmed the robustness of the findings.</p> Conclusion <p>LND provides an OS benefit in high-risk early stage endometrial cancer patients, reinforcing its role in accurate staging and individualized treatment planning. Although PFS improvement was less evident, the findings support the continued use of LND, particularly for optimizing outcomes in high-risk patient subsets.</p>

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The Impact of Lymphadenectomy on Survival Outcomes in Preoperative Early Stage Endometrial Cancer with Intermediate to High Risk: A Systematic Review and Meta-analysis

  • 期刊论文

  • 发表日期：

    2025年9月10日

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  • Candra Novi Ricardo Sibarani,
  • Siti Salima,
  • Gatot Nyarumenteng Adhipurnawan Winarno,
  • Dodi Suardi,
  • Nicholas Adrianto,
  • Ghea Mangkuliguna

摘要

Purpose

This meta-analysis aimed to evaluate the impact of lymphadenectomy (LND) on overall survival (OS) and progression-free survival (PFS) in intermediate- and high-risk early stage EC patients.

Methods

A systematic literature search was conducted across PubMed, ScienceDirect, Cochrane Library, EBSCOHost, ProQuest, and Google Scholar for articles published between February 27, 2000, and February 27, 2024. Studies were included if they compared outcomes between patients undergoing lymphadenectomy and those who did not, focusing on OS and PFS in intermediate- and high-risk groups. Data extraction and risk of bias assessments were performed independently by multiple reviewers following PRISMA guidelines. Meta-analyses using hazard ratios (HR) with 95% confidence intervals (CI) were conducted using Review Manager and MedCalc software. Heterogeneity, publication bias, and sensitivity analyses were also evaluated. The protocol was registered in PROSPERO (CRD42024574157).

Results

Seven studies encompassing 18,918 patients were included. LND was associated with a significant OS benefit in high-risk patients (HR 0.62, 95% CI 0.43–0.91), with less pronounced effects in intermediate-risk groups. No statistically significant PFS benefit was observed overall (HR 0.70, 95% CI 0.43–1.12), although subgroup analysis suggested improved outcomes for high-risk patients. Substantial heterogeneity was noted across studies, particularly in OS analyses. The pooled proportion of positive lymph nodes was higher in high-risk patients (20.91%) compared to intermediate-risk patients (8.42%). Publication bias was not detected, and sensitivity analysis confirmed the robustness of the findings.

Conclusion

LND provides an OS benefit in high-risk early stage endometrial cancer patients, reinforcing its role in accurate staging and individualized treatment planning. Although PFS improvement was less evident, the findings support the continued use of LND, particularly for optimizing outcomes in high-risk patient subsets.