Miao Ao

Predictive factors of sentinel lymph node mapping failure in cervical cancer: A systematic review and meta-analysis

Sentinel lymph node (SLN) mapping is crucial in cervical cancer, helping to assess lymph node status while reducing unnecessary systemic lymph node dissection. However, bilateral SLN mapping fails in 5 %-20 % of cases, with various contributing factors. This meta-analysis aims to identify predictive factors associated with SLN mapping failure in cervical cancer. A comprehensive literature search was conducted across Cochrane, MEDLINE, Embase, PubMed, Web of Science, CBM, CNKI, WFDB, and VIP from inception to July 2024. Additional data were obtained from SRCTN, Physicians Data Query, ClinicalTrials, and the International Clinical Trials Registry Platform. Two independent researchers screened studies, assessed quality, and extracted data. The associations between predictive factors and SLN mapping failure were evaluated using odds ratios (ORs) with 95 % confidence intervals (CIs). A total of 27 observational studies comprising 4059 patients were included. Significant predictive factors for SLN mapping failure included tumor size ≥2 cm [OR = 1.35, 95 % CI (1.05, 1.74), P = 0.018], age ≥50 years [OR = 2.71, 95 % CI (1.85, 3.97), P ≤ 0.001], FIGO stages II-IV [OR = 2.11, 95 % CI (1.20, 3.72), P = 0.009], pelvic lymph node metastasis [OR = 2.15, 95 % CI (1.10, 4.20), P = 0.025], and neoadjuvant chemotherapy (NACT) [OR = 1.44, 95 % CI (1.09, 1.90), P = 0.010]. Other factors including obesity, surgical approach, cervical conization, tumor differentiation, lymphovascular space invasion (LVSI), and histologic type were not associated with SLN mapping failure. Larger tumor, older age, advanced FIGO stage, pelvic lymph node metastasis, and NACT are predictive factors for SLN mapping failure. These findings highlight the importance of preoperative assessment before SLN mapping.

Lymph node dissection before initial treatment for locally advanced cervical cancer: A systematic review and meta-analysis

The effectiveness of removing lymph nodes before initial treatment in patients with locally advanced cervical cancer is still debated. This article presents a meta-analysis that systematically evaluates the impact of this approach on oncological outcomes. A systematic literature search of PubMed, Embase, Science Direct, and the Cochrane Database of Systematic Reviews (up to December 2023) was performed to obtain relevant studies. The findings were combined using fixed-effects models to address potential differences. Combined risk ratios (HR) and 95% confidence intervals (CI) were calculated. Egger's test was used to assess publication bias. Out of 1025 screened articles, four studies (involving 838 women) met the inclusion criteria. The results showed that lymph node dissection before initial treatment did not affect overall survival (OS) in patients with locally advanced cervical cancer compared to concurrent radiotherapy (HR = 1.11, 95% CI = 0.91-1.36, P = 0.30). It also did not increase the incidence of postoperative complications or cause delays in radiotherapy. In particular, removing larger lymph nodes (>2cm) aided in defining the radiation field and decreasing radiotherapy-related complications. The surgical technique also had some impact on postoperative complications. In summary, in order to obtain the best therapeutic outcomes, personalized plans should be developed for each patient, accounting for their individual circumstances to achieve precise treatment and enhance their quality of life.