Abstract 1637P
Background
Although the use of adjuvant chemotherapy (AC) appears to be increasing over the past few years, several clinical trials and previous meta-analyses failed to determine whether AC could improve clinical outcomes in uterine leiomyosarcoma (uLMS). Thus, we performed a systematic review and meta-analysis to compare AC (with or without radiotherapy) versus observation after primary surgery in early stage uLMS.
Methods
Randomized controlled trials (RCTs) and non-randomized studies (NRSs) published from June 15, 1985 to March 29, 2020 comparing AC versus observation (obs) in completely resected, early stage uLMS, were retrieved through PubMed/Med, Cochrane library and EMBASE databases. Outcomes of interest were as follows: distant recurrence rate (AC versus obs), locoregional recurrence rate (AC versus obs) and overall recurrence rate (AC versus obs and AC ± radiotherapy versus obs). Results about distant recurrence rate, locoregional recurrence rate and overall recurrence rate were compared by calculating Odds Ratios (ORs) with 95% confidence intervals (CIs); ORs were combined with Mantel-Haenszel method. Statistical heterogeneity between studies was examined using the Chi-square test and the I2 statistic; substantial heterogeneity was considered to exist when the I2 value was greater than 50% or there was a low P value (<0.10) in the Chi-square test.
Results
Nine studies were included in the analysis, involving 545 patients (AC: 252, obs: 293). Compared with obs, AC did not reduce locoregional and distant recurrence rate, with a pooled OR of 1.36 (95%CI=0.61-3.05) and 0.63 (95%CI=0.33-1.20), respectively. Similarly, administration of AC did not decrease overall recurrence rate in comparison to obs (OR=0.72 [95%CI=0.33-1.52] in AC versus obs; OR 0.78 [95%CI=0.43-1.43] in AC ± radiotherapy versus obs).
Conclusions
According to our results, AC (with or without radiotherapy) did not decrease recurrence rate in early stage uLMS; thus, the role of AC in this setting remains unclear. Given the substantial heterogeneity affecting part of our analyses, our results should be interpreted with caution. In the era of tailor-made medicine, future studies should be more focused on genomic assessment of uLMS.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.