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Evaluation of the efficacy of systemic therapy for advanced uterine leiomyosarcoma: A systematic review, meta-analysis, and meta-regression analysis
Cancer Medicine ( IF 2.9 ) Pub Date : 2023-04-20 , DOI: 10.1002/cam4.5930 Iqra Ijaz 1, 2 , Muhammad Naveed Shahzad 3 , Hossein Hosseinifard 4 , Shuya Liu 5 , Masoud Ostadi Sefidan 6 , Lubna Ejaz Kahloon 2 , Saber Imani 7 , Zhong Hua 8 , Yu Qin Zhang 5
Cancer Medicine ( IF 2.9 ) Pub Date : 2023-04-20 , DOI: 10.1002/cam4.5930 Iqra Ijaz 1, 2 , Muhammad Naveed Shahzad 3 , Hossein Hosseinifard 4 , Shuya Liu 5 , Masoud Ostadi Sefidan 6 , Lubna Ejaz Kahloon 2 , Saber Imani 7 , Zhong Hua 8 , Yu Qin Zhang 5
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Uterine leiomyosarcoma (uLMS) is an aggressive mesenchymal neoplasm associated with a poor prognosis. Systemic chemotherapy is the standard therapy for patients with uLMS. However, it is unclear which treatment regimen results in the most favorable clinical outcome. We performed a meta-analysis and meta-regression analysis to assess the efficiency of different treatments received by patients with advanced, metastatic, and relapsing uLMS by evaluating the objective response rate (ORR) and disease control rate (DCR) as primary endpoints. The frequentist random effects meta-analysis model was used to compare the outcomes of different treatment regimens for advanced uLMS. A meta-regression analysis was performed to estimate the association between the study-specific hazard ratios and specific demographic variables. A meta-analysis of 51 reports including 1664 patients was conducted. Among patients who received adjuvant chemotherapy (916 patients; 55%), gemcitabine and docetaxel were the most frequently used drugs. First-line monotherapy with alkylating agents (pooled ORR = 0.48; 95% confidence interval [CI]: 0.44–0.52) and second-line monotherapy with protein kinase inhibitors (pooled ORR = 0.45; 95% CI: 0.39–0.52) resulted in favorable prognoses. The combinations of anthracycline plus alkylating therapy (pooled DCR = 0.74; 95% CI: 0.67–0.79) and of gemcitabine plus docetaxel (pooled DCR = 0.70; 95% CI: 0.63–0.75) showed the greatest benefits when used as first-line and second-line chemotherapies, respectively. Subgroup meta-analysis results revealed that dual-regimen therapies comprising anthracycline plus alkylating therapy and gemcitabine plus docetaxel are practical therapeutic choices for International Federation of Gynecology and Obstetrics stages III–IVb with distant metastases when assessed by computed tomography (p = 0.001). Furthermore, neoadjuvant chemotherapy and local radiotherapy resulted in favorable outcomes for patients with earlier stages of distant relapsed uLMS (p < 0.001). Our findings provide a basis for designing new therapeutic strategies and can potentially guide clinical practice toward better prognoses for uLMS patients with advanced, metastatic, and relapsing disease.
中文翻译：
晚期子宫平滑肌肉瘤全身治疗的疗效评价：系统评价、荟萃分析和荟萃回归分析
子宫平滑肌肉瘤（uLMS）是一种侵袭性间叶性肿瘤，预后不良。全身化疗是 uLMS 患者的标准治疗方法。然而，尚不清楚哪种治疗方案能产生最有利的临床结果。我们进行了荟萃分析和荟萃回归分析，通过评估客观缓解率 (ORR) 和疾病控制率 (DCR) 作为主要终点，评估晚期、转移性和复发性 uLMS 患者接受的不同治疗的效率。使用频率随机效应荟萃分析模型来比较晚期 uLMS 不同治疗方案的结果。进行荟萃回归分析以估计研究特定风险比与特定人口变量之间的关联。对 51 份报告（包括 1664 名患者）进行了荟萃分析。在接受辅助化疗的患者中（916 名患者；55%），吉西他滨和多西他赛是最常用的药物。一线烷化剂单一疗法（汇总 ORR = 0.48；95% 置信区间 [CI]：0.44–0.52）和二线蛋白激酶抑制剂单一疗法（汇总 ORR = 0.45；95% CI：0.39–0.52）导致良好的预测。蒽环类药物联合烷化疗法（汇总 DCR = 0.74；95% CI：0.67–0.79）和吉西他滨联合多西他赛（汇总 DCR = 0.70；95% CI：0.63–0.75）的组合在用作一线时显示出最大的益处分别是二线化疗和二线化疗。亚组荟萃分析结果显示，通过计算机断层扫描评估时，包括蒽环类加烷化疗法和吉西他滨加多西紫杉醇的双方案治疗是国际妇产科联合会 III-IVb 期远处转移的实用治疗选择（p = 0.001 ） 。此外，新辅助化疗和局部放疗为早期远处复发性 uLMS 患者带来了良好的结果 ( p < 0.001)。我们的研究结果为设计新的治疗策略提供了基础，并有可能指导临床实践，为患有晚期、转移性和复发性疾病的 uLMS 患者提供更好的预后。
更新日期：2023-04-20
中文翻译：
晚期子宫平滑肌肉瘤全身治疗的疗效评价：系统评价、荟萃分析和荟萃回归分析
子宫平滑肌肉瘤（uLMS）是一种侵袭性间叶性肿瘤，预后不良。全身化疗是 uLMS 患者的标准治疗方法。然而，尚不清楚哪种治疗方案能产生最有利的临床结果。我们进行了荟萃分析和荟萃回归分析，通过评估客观缓解率 (ORR) 和疾病控制率 (DCR) 作为主要终点，评估晚期、转移性和复发性 uLMS 患者接受的不同治疗的效率。使用频率随机效应荟萃分析模型来比较晚期 uLMS 不同治疗方案的结果。进行荟萃回归分析以估计研究特定风险比与特定人口变量之间的关联。对 51 份报告（包括 1664 名患者）进行了荟萃分析。在接受辅助化疗的患者中（916 名患者；55%），吉西他滨和多西他赛是最常用的药物。一线烷化剂单一疗法（汇总 ORR = 0.48；95% 置信区间 [CI]：0.44–0.52）和二线蛋白激酶抑制剂单一疗法（汇总 ORR = 0.45；95% CI：0.39–0.52）导致良好的预测。蒽环类药物联合烷化疗法（汇总 DCR = 0.74；95% CI：0.67–0.79）和吉西他滨联合多西他赛（汇总 DCR = 0.70；95% CI：0.63–0.75）的组合在用作一线时显示出最大的益处分别是二线化疗和二线化疗。亚组荟萃分析结果显示，通过计算机断层扫描评估时，包括蒽环类加烷化疗法和吉西他滨加多西紫杉醇的双方案治疗是国际妇产科联合会 III-IVb 期远处转移的实用治疗选择（p = 0.001 ） 。此外，新辅助化疗和局部放疗为早期远处复发性 uLMS 患者带来了良好的结果 ( p < 0.001)。我们的研究结果为设计新的治疗策略提供了基础，并有可能指导临床实践，为患有晚期、转移性和复发性疾病的 uLMS 患者提供更好的预后。
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