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Lymphadenectomy for primary ovarian cancer: a systematic review and meta-analysis
Tatsuyuki Chiyoda,Manabu Sakurai,Toyomi Satoh,Satoru Nagase,Mikio Mikami,Hidetaka Katabuchi,Daisuke Aoki 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.5
Objective: To assess the effectiveness of lymphadenectomy at primary debulking surgery(PDS) on the survival of patients with epithelial ovarian cancer (EOC). Methods: We searched PubMed, Ichushi, and the Cochrane Library. Randomized controlledtrials (RCTs) and retrospective cohort studies comparing survival of women with EOCundergoing lymphadenectomy at PDS with that of women without lymphadenectomy wereincluded. We performed a meta-analysis of overall survival (OS), progression-free survival(PFS), and adverse events. Results: For advanced-stage EOC, 2 RCTs including 1,074 women and 7 cohort studiescomprising 3,161 women were evaluated. Meta-analysis revealed that lymphadenectomy wasassociated with improved OS (hazard ratio [HR]=0.80; 95% confidence interval [CI]=0.70–0.90). However, meta-analysis of 2 RCTs revealed no significant difference in OS betweenthe lymphadenectomy and no-lymphadenectomy groups (OS: HR=1.02; 95% CI=0.85–1.22). For early-stage EOC, 1 RCT comprising 268 women and 4 cohort studies comprising 14,228women were evaluated. Meta-analysis showed that lymphadenectomy was associatedwith improved OS (HR=0.75; 95% CI=0.68–0.82). A RCT of early-stage EOC reported thatlymphadenectomy was not associated with improved OS (HR=0.85; 95% CI=0.49–1.47). Surgery-related deaths were similar in both groups (risk ratio [RR]=1.00; 95% CI=0.99–1.01);however, blood transfusion was required less frequently in the no-lymphadenectomy group(RR=0.74; 95% CI=0.63–0.86). Conclusions: Meta-analysis of RCTs and observational studies suggest thatlymphadenectomy was associated with improved OS in advanced- and early-stage EOC. However, results from RCTs demonstrate that lymphadenectomy was not associated withimproved OS in advanced- and early-stage EOC.
Mamiko Onuki,Koji Matsumoto,Manabu Sakurai,Hiroyuki Ochi,Takeo Minaguchi,Toyomi Satoh,Hiroyuki Yoshikawa 대한부인종양학회 2016 Journal of Gynecologic Oncology Vol.27 No.1
Objective: We conducted a pooled analysis of published studies to compare the performance of human papillomavirus (HPV) testing and cytology in detecting residual or recurrent diseases after treatment for cervical intraepithelial neoplasia grade 2 or 3 (CIN 2/3). Methods: Source articles presenting data on posttreatment HPV testing were identified from the National Library of Medicine (PubMed) database. We included 5,319 cases from 33 articles published between 1996 and 2013. Results: The pooled sensitivity of high-risk HPV testing (0.92; 95% confidence interval [CI], 0.90 to 0.94) for detecting posttreatment CIN 2 or worse (CIN 2+) was much higher than that of cytology (0.76; 95% CI, 0.71 to 0.80). Co-testing of HPV testing and cytology maximized the sensitivity (0.93; 95% CI, 0.87 to 0.96), while HPV genotyping (detection of the same genotype between pre- and posttreatments) did not improve the sensitivity (0.89; 95% CI, 0.82 to 0.94) compared with high-risk HPV testing alone. The specificity of high-risk HPV testing (0.83; 95% CI, 0.82 to 0.84) was similar to that of cytology (0.85; 95% CI, 0.84 to 0.87) and HPV genotyping (0.83; 95% CI, 0.81 to 0.85), while co-testing had reduced specificity (0.76; 95% CI, 0.75 to 0.78). For women with positive surgical margins, high-risk HPV testing provided remarkable risk discrimination between test-positives and test-negatives (absolute risk of residual CIN 2+ 74.4% [95% CI, 64.0 to 82.6] vs. 0.8% [95% CI, 0.15 to 4.6]; p<0.001). Conclusion: Our findings recommend the addition of high-risk HPV testing, either alone or in conjunction with cytology, to posttreatment surveillance strategies. HPV testing can identify populations at greatest risk of posttreatment CIN 2+ lesions, especially among women with positive section margins.