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

Gynecol Oncol. 2019 Sep;154(3):638-650. doi: 10.1016/j.ygyno.2019.07.001. Epub 2019 Jul 12.

Abstract

Objectives: To 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).

Methods: We 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.

Results: Three 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.

Conclusion: AC, including gemcitabine/docetaxel regimen, or AR did not reduce the recurrence rate in patients with early-stage uLMS.

Keywords: Chemotherapy; Leiomyosarcoma; Meta-analysis; Prognosis; Radiotherapy.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Chemotherapy, Adjuvant
  • Deoxycytidine / administration & dosage
  • Deoxycytidine / analogs & derivatives
  • Docetaxel / administration & dosage
  • Female
  • Humans
  • Leiomyosarcoma / drug therapy
  • Leiomyosarcoma / radiotherapy
  • Leiomyosarcoma / surgery
  • Leiomyosarcoma / therapy*
  • Observational Studies as Topic
  • Radiotherapy, Adjuvant
  • Randomized Controlled Trials as Topic
  • Uterine Neoplasms / drug therapy
  • Uterine Neoplasms / radiotherapy
  • Uterine Neoplasms / surgery
  • Uterine Neoplasms / therapy*

Substances

  • Deoxycytidine
  • Docetaxel
  • gemcitabine