A systematic literature search was conducted on electronic databases (PubMed, Cochrane, EMBASE and Web of Science) until May 24, 2022, followed by a manual search. Based on inclusion and exclusion criteria, publications investigating long-term survival outcomes after RALS vs CLS or LT in endometrial cancer patients were collected. The primary outcomes included overall survival (OS), disease-specific survival (DSS), recurrence-free survival (RFS) and disease-free survival (DFS). Fixed effects models or random effects models were employed to calculate the pooled hazard ratios (HRs) and 95% confidence intervals (CIs) as appropriate. Heterogeneity and publication bias were also assessed.
RALS and CLS had no difference in OS (HR = 0.962, 95% CI: 0.922-1.004), RFS (HR = 1.096, 95% CI: 0.947-1.296), and DSS (HR = 1.489, 95% CI: 0.713-3.107) for endometrial cancer; however, RALS was significantly associated with favorable OS (HR = 0.682, 95% CI: 0.576-0.807), RFS (HR = 0.793, 95% CI: 0.653-0.964), and DSS (HR = 0.441, 95% CI: 0.298-0.652) when compared with LT. In the subgroup analysis of effect measures and follow-up length, RALS showed comparable or superior RFS/OS to CLS and LT. In early-stage endometrial cancer patients, RALS had similar OS but worse RFS than CLS.
RALS is safe in the management of endometrial cancer, with long-term oncological outcomes equivalent to CLS and superior to LT.
方法:在电子数据库上进行了系统的文献检索(PubMed,科克伦,EMBASE和WebofScience),直到2022年5月24日,然后进行手动搜索。根据纳入和排除标准,收集了研究子宫内膜癌患者接受RALSvsCLS或LT治疗后长期生存结局的出版物.主要结果包括总生存期(OS),疾病特异性生存率(DSS),无复发生存期(RFS)和无病生存期(DFS)。采用固定效应模型或随机效应模型来计算合并风险比(HR)和95%置信区间(CI)。还评估了异质性和发表偏倚。
结果:RALS和CLS在OS上没有差异(HR=0.962,95%CI:0.922-1.004),RFS(HR=1.096,95%CI:0.947-1.296),和DSS(HR=1.489,95%CI:0.713-3.107)用于子宫内膜癌;然而,RALS与良好的OS显著相关(HR=0.682,95%CI:0.576-0.807),RFS(HR=0.793,95%CI:0.653-0.964),与LT相比,DSS(HR=0.441,95%CI:0.298-0.652)。在效应测量和随访时间的亚组分析中,RALS显示与CLS和LT相当或优于RFS/OS。在早期子宫内膜癌患者中,RALS的OS相似,但RFS比CLS差。
结论:RALS在子宫内膜癌的治疗中是安全的,长期肿瘤结局相当于CLS,优于LT。