Role of lymph node involvement and lymphadenectomy in patients with different subtypes of uterine sarcoma: a systematic review and meta-analysis

Abstract Background We meta-analyzed the available data on the influence of lymph node involvement (LNI) and lymphadenectomy on the prognosis of patients with uterine sarcoma. Method PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus, OpenGrey, and ClinicalTrials.gov were searched for articles related to LNI or lymphadenectomy in patients diagnosed with any of the following subtypes of uterine sarcoma: uterine leiomyosarcoma (uLMS), low-grade endometrial stromal sarcoma (LGESS), high-grade endometrial stromal sarcoma (HGESS), undifferentiated uterine sarcoma (UUS), and adenosarcoma (ADS). Data on the incidence rates of LNI, lymphadenectomy, and survival were independently extracted and pooled using a random-effects model. Heterogeneity was evaluated using the I 2 statistic. Result A total of 25 studies with 19,926 patients were included in our meta-analysis. LNI was more common in patients with HGESS/UUS [rate 18%; 95% confidence interval (CI) 95%: 9–28%], but less in uLMS (rate 6%; 95% CI 4–8%), LGESS (rate 7%; 95% CI 4–11%), or ADS (rate 2%; 95% CI 1–3%). Lymphadenectomy did not improve overall survival in patients with LGESS [hazard ratio (HR) 1.21, 95% CI 0.95–1.54], ADS (HR 0.90, 95% CI 0.73–1.10) or uLMS (HR 1.14, 95% CI 1.03–1.27), but it did improve overall survival in patients with HGESS/UUS (HR 0.63, 95% CI 0.48–0.85). Lymphadenectomy did not improve disease-free survival in patients with uLMS or ADS (HR 0.87, 95% CI 0.61–1.26). Conclusion LNI is relatively infrequent among patients with uLMS, LGESS, or ADS, and lymphadenectomy in such patients does not appear to improve survival. In contrast, LNI is relatively common among patients with HGESS/UUS, and lymphadenectomy significantly improves overall survival. The available evidence supports routine lymphadenectomy for patients with HGESS or UUS, but not those with uLMS, LGESS, or ADS. Trial registration: This meta-analysis registered with PROSPERO (CRD42022353507).