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Ritchie Delara,Jie Yang,Skye Buckner-Petty,Paul Magtibay,Kristina Butler 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.6
Objective: To evaluate the survival impact of imaging vs surgical nodal assessment inpatients with cervical cancer stage IB2–IVA prior to definitive chemoradiotherapy (CRT). Methods: PubMed, MEDLINE, Cochrane Library, and ClinicalTrials.gov were used to searchfor publications in English and Chinese over a 50-year period. The Preferred ReportingItems for Systematic Reviews and Meta-Analyses Protocols was used to conduct this review. Inclusion criteria were studies that compared survival outcomes in International Federationof Gynecology and Obstetrics 2009 stage IB2–IVA cervical cancer patients with pre-therapypelvic and/or aortic lymphadenectomy (LND) or imaging. One or more of the followingmodalities were used for nodal assessment: computed tomography (CT), magnetic resonanceimaging, or positron emission tomography-CT. The National Institutes of Health QualityAssessment Tool was utilized to assess study quality. Results: The initial search identified 65 studies, and five met the inclusion criteria. There werea total of 1,112 patients. Seven hundred and fifty-four underwent pelvic and/or aortic LND and358 had imaging. When compared to LND, imaging had a sensitivity and specificity of 88.9%and 22.2% for pelvic lymph node (LN), and 33%–62.5% and 92%–95.5% for para-aortic LN. There were no differences in progression-free survival (PFS) (hazard ratio [HR]=1.13; 95%confidence interval [CI]=0.73–1.74; I2=75%; p<0.01) and overall survival (OS) (HR=1.06; 95%CI=0.66–1.69; I2=75%; p<0.01) between surgical and imaging nodal assessment. Conclusions: Imaging and surgical nodal assessment has comparable PFS and OS in patientswith cervical cancer stage IB2–IVA. Trial Registration: PROSPERO Identifier: CRD42020155486
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