Recurrence and survival of patients with stage III endometrial cancer after radical surgery followed by adjuvant chemo- or chemoradiotherapy: a systematic review and meta-analysis

Objective: To compare recurrence and survival in patients with stage III endometrial cancer after radical surgery, followed by either adjuvant chemoradiotherapy (ACR) or adjuvant chemotherapy (AC). Methods We searched for relevant studies in PubMed Central, Embase and the Cochrane Central Register of Controlled Trials. Data were pooled on rates of recurrence as well as rates of progression-free, disease-free and overall survival. Heterogeneity was evaluated using the I 2 test. Subgroup and sensitivity analyses were performed to identify potential sources of heterogeneity. Results Data from 55,440 patients in 22 retrospective studies and one randomized controlled trial were meta-analyzed. Compared to the AC group, the ACR showed significantly lower risk of local recurrence (OR 0.43, 95%CI 0.31–0.58) and total recurrence (OR 0.71, 95%CI 0.58–0.87). ACR was also associated with significantly better overall survival (HR 0.68, 95%CI 0.63–0.74), progression-free survival (HR 0.54, 95%CI:0.38–0.77) and disease-free survival (HR 0.54, 95%CI 0.30–0.96). Conclusions Adding adjuvant radiotherapy to adjuvant chemotherapy after radical surgery may significantly reduce risk of local and overall recurrence, while significantly improving survival of patients with stage III endometrial cancer.