Effect of adjuvant therapy on the risk of recurrence in early-stage leiomyosarcoma: A meta-analysis

• Published in: Gynecologic oncology Vol. 154; no. 3; pp. 638 - 650
• Main Authors: Chae, Su Hyun, Shim, Seung-Hyuk, Chang, Misoo, Choi, Ah Young, Kang, Gun Gu, Lee, Sun Joo, Kim, Soo-Nyung
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2019
• Subjects: Chemotherapy; Hematology, Oncology, and Palliative Medicine; Leiomyosarcoma; Meta-analysis; Obstetrics and Gynecology; Prognosis; Radiotherapy; Chemotherapy; Prognosis; Radiotherapy; Leiomyosarcoma; Meta-analysis
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2019.07.001

AbstractObjectivesTo assess the effect of adjuvant chemotherapy (AC) or radiotherapy (AR) on the risk of recurrence in surgically treated patients with early-stage uterine leiomyosarcoma (uLMS). MethodsWe searched the PubMed, EMBASE, and MEDLINE, and Cochrane databases for publications up to March 2019, which compared patients with early-stage uLMS who received AC or AR with those who did not. The primary endpoint was recurrence rate. Random- or fixed-effects models were used for pooled estimates of the effect of adjuvant treatments on recurrence rates. Subgroup analyses were conducted based on study design, surgical staging, AC regimen (gemcitabine/docetaxel regimen), and type of AR. ResultsThree randomized trials and 9 observational studies (9 studies for AC vs. observation, n = 496; 9 studies for AR vs. observation, n = 425) were included. The meta-analysis indicated that AC did not decrease the risk of recurrence compared with observation (odds ratio [OR] = 0.65, 95% confidence interval [CI] = 0.37–1.15, P =  0.14; P =  0.09 and I2 =  42.1). Similarly, AR did not decrease the risk of recurrence compared with observation (OR = 1.11, 95% CI = 0.56–2.21, P =  0.76; P =  0.10 and I2 =  40.4). Meta-regression analyses revealed no significant association between median follow-up time and recurrence. In subgroup analyses (study design, surgical staging, gemcitabine/docetaxel regimen, type of AR), neither AC nor AR decreased the risk of recurrence significantly. ConclusionAC, including gemcitabine/docetaxel regimen, or AR did not reduce the recurrence rate in patients with early-stage uLMS.