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Microscopic Omental Metastasis in Clinical Stage I Endometrial Cancer: A Meta-analysis

Abstract

Background

A patient with early-stage endometrial cancer may possibly have microscopic metastasis in the omentum, which is associated with a poor prognosis. The purpose of this study was to identify risk factors for microscopic omental metastasis in patients with clinical stage I endometrial cancer to establish the indications for selective omentectomy.

Methods

We searched the PubMed, EMBASE, and Cochrane Library databases for published studies from inception to August 2014, using terms such as ‘endometrial cancer’ or ‘uterine cancer’ for disease, ‘omentectomy’ or ‘omental biopsy’ for intervention, and ‘metastasis’ for outcome. Two reviewers independently identified the studies that matched the selection criteria. We calculated the pooled risk ratios (RRs) with 95 % confidence intervals (CI) of each surgicopathologic finding for microscopic omental metastases in clinical stage I endometrial cancer. We also calculated the prevalence of microscopic omental metastases.

Results

Among 1163 patients from ten studies, 22 cases (1.9 %) of microscopic omental metastases were found, which accounted for 26.5 % of all omental metastases. Positive lymph nodes (RR 8.71, 95 % CI 1.38–54.95), adnexal metastases (RR 16.76, 95 % CI 2.60–107.97), and appendiceal implants (RR 161.67, 95 % CI 5.16–5061.03) were highly associated with microscopic omental metastases.

Conclusions

Microscopic omental metastases were not negligible in patients with clinical stage I endometrial cancer. Those with a risk factor of microscopic omental metastases were recommended for selective omentectomy.

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Fig. 1

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Acknowledgment

This study was supported by a grant from the Korea Healthcare Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (A070001). The study was presented as a poster abstract at the Society of Gynecologic Oncology 44th Annual Meeting on Women’s Cancer, Los Angeles, CA, USA, on 10 March 2013.

Disclosure

Won Duk Joo, Peter E. Schwartz, Thomas J. Rutherford, Seok Ju Seong, Junbeom Ku, Hyun Park, Sang Geun Jung, Min Chul Choi, and Chan Lee report no conflicts of interest.

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Correspondence to Seok Ju Seong MD, PhD.

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Supplementary Fig. 1s

Forest plots, the risk of microscopic omental metastases and (a) positive lymph nodes; (b) adnexal metastases; (c) appendiceal implants; (d) positive cytology; (e) deep myometrial invasion (≥1/2); (f) histological grade 3 versus grade 1 and 2; (g) histological grade 3 and 2 versus grade 1. LN, lymph node; MM, myometrial. Supplementary material 1 (EPS 3368 kb)

Supplementary Fig. 2s

Funnel plots of studies included in the meta-analysis of the risk of microscopic omental metastases and (a) positive lymph nodes; (b) adnexal metastases; (c) deep myometrial invasion (≥1/2); (d) histological grade 3 versus grade 1 and 2; (e) histological grade 3 and 2 versus grade 1. All studies lay inside the funnels with symmetric distribution, suggesting no publication bias in the meta-analysis. LN, lymph node; MM, myometrial Supplementary material 2 (EPS 148 kb)

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Joo, W.D., Schwartz, P.E., Rutherford, T.J. et al. Microscopic Omental Metastasis in Clinical Stage I Endometrial Cancer: A Meta-analysis. Ann Surg Oncol 22, 3695–3700 (2015). https://doi.org/10.1245/s10434-015-4443-1

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  • DOI: https://doi.org/10.1245/s10434-015-4443-1

Keywords

  • Endometrial Cancer
  • Clinical Stage
  • Endometrioid Adenocarcinoma
  • Positive Cytology
  • Cochrane Library Database