| Objective: Sentinel lymph node mapping is increasingly being utilized for endometrial cancer staging.However,only limited evidence supporting the adoption of sentinel node mapping instead of conventional lymphadenectomy is still available.Here,we aimed to review the current evidence comparing sentinel lymph node mapping and lymphadenectomy in endometrial cancer staging and tumor prognosis through a meta-analysis,and then to assess non-inferiority of sentinel lymph node mapping.Methods: The literature search was performed comprehensively,using several databases from Pub Med,Embase,Web of science,Cochrane Library,CNKI,CBM,VIP and WANFANG Data,associated with patients of endometrial cancer who were underwent sentinel lymph node mapping and lymphadenectomy.Related literatures were published from each database’s earliest inception to April 31,2020.The language was limited to English and Chinese only.The quality of the included studies was evaluated after literature screening.Odds ratios(OR)and hazard ratios(HR)were used to demonstrate the impact of sentinel lymph node mapping and lymphadenectomy on tumor metastasis and prognosis respectively.The meta-analysis was performed using the STATA11.0 software.Results: Eleven comparative studies were included.Overall,4756 patients were included,1808(38.0%)and 2948(62.0%),undergoing sentinel lymph node mapping and lymphadenectomy,respectively.Pooled data suggested that the mapped group had more positive lymph nodes detected overall compared to lymphadenectomy group(14.87% vs.10.75%.OR=2.162,95%CI: 1.728-2.704;p<0.001),and more positive pelvic lymph nodes(13.55% vs.9.87%.OR=1.959,95%CI: 1.312-2.925;p=0.001).No difference in detection of positive nodes located in the para-aortic was observed between the two groups(SLN vs.LND: 2.64% vs.3.15%;OR=1.187,95%CI: 0.787-1.791;p= 0.413).A total of10 studies reported the rates of postoperative adjuvant therapy but they did not differ between the two groups(48.70% vs.45.46%;OR=1.091,95%CI:0.656-1.813;p=0.737).There was no significant difference in the overall recurrence rate between sentinel lymph node mapping and lymphadenectomy(8.87% vs.13.30%,OR=0.843,95%CI: 0.633-1.124;p=0.245).Similarly,nodal recurrences were statistically similar between groups(2.04% vs.2.85%;OR=1.048,95%CI: 0.602-1.827;p=0.868).The recurrence rate of distant metastasis was 5.29% and 6.96% after sentinel lymph node mapping and lymphadenectomy,respectively(OR=0.999,95%CI: 0.693-1.439;p=0.995).A total of 4 studies reported the progression-free survival(PFS),3 studies compared disease-free survival(DFS),and 5 studies reported the overall survival(OS).Pooled data showed that comparing with lymphadenectomy,SLN was associated with improved PFS(HR = 0.782,95% CI: 0.614-0.996,p =0.046),however,the comparison did not show a significant difference in the strategy adopted for nodal staging,regarding DFS(HR=0.774,95% CI:0.516-1.162,p = 0.217)or OS(HR= 0.754,95%CI: 0.433-1.313,p=0.318).Conclusion: Our meta-analysis underlines that focusing on the ability to detect positive pelvic nodes,sentinel lymph node mapping could be consider superior to lymphadenectomy,but it did not differ on detection of para-aortic nodal involvement.In terms of tumor prognosis,sentinel lymph node mapping is non-inferior to standard lymphadenectomy about OS,DFS and recurrence rates(overall recurrence rate,nodal recurrence and distant metastasis recurrence rate),while,it was associated with improved PFS.Additionally,sentinel lymph node mapping had no significant effect on postoperative adjuvant therapy rate.Further randomized studies are needed to asses long term effectiveness of sentinel lymph node mapping. |
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