The prognostic significance and role of adjuvant therapy for low-volume nodal metastasis in apparent early stage endometrial cancer - an updated systematic review and meta-analysis

Q: What clinical question does the study address about LVNM in early-stage endometrial cancer?

It evaluates the prognostic significance of low-volume nodal metastasis and whether adjuvant therapy is needed to improve outcomes.

Q: How were patients grouped for analysis in the systematic review and meta-analysis?

Patients were categorized based on nodal status as macrometastases (MAC), micrometastases (MM), isolated tumor cells (ITCs), or negative nodes.

Q: What were the main comparative findings regarding recurrence/progression risk and survival?

The MM group had lower recurrence or progression risk than MAC but higher risk than negative nodes, and survival metrics differed accordingly; AT reduced the recurrence/progression risk in MM and improved overall survival in ITC.

Sep 23, 2026

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Sentinel lymph node biopsy (SLNB) enables detection of low-volume node metastasis (LVNM) in apparent early-stage endometrial cancer, yet the prognostic meaning and value of adjuvant therapy (AT) remain unsettled. A comprehensive search through August 31, 2024 identified 21 studies with 65,228 patients classified as macrometastases (MAC), micrometastases (MM), isolated tumor cells (ITCs), or negative nodes. MM showed different recurrence and survival patterns versus MAC and negative nodes, while AT modified risks and improved overall outcomes. The study concludes early-stage EC with LVNM has better prognoses than MAC, but requires prospective randomized trials.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages22

Reading Time55 min

AccessFree to download

Abstract

Objective

Methods

Results

Conclusion

Trial registration

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Conflict of interest

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37TH ANNUAL CONFERENCE OF THE INTERNATIONAL PAPILLOMAVIRUS SOCIETY Research toward the global elimination of HPV-related diseases and cancers OCTOBER23-26, 2025 | BANGKOK, THAILAND DON’T MISS THESE IMPORTANT DATES ENJOY AN EXCLUSIVE 10% DISCOUNT [ipvconference.org | \#IPVS2025](ipvconference.org | #IPVS2025) J Gynecol Oncol. 2025 Sep;36(5):e67 [https://doi.org/10.3802/jgo.2025.36.e67](https://doi.org/10.3802/jgo.2025.36.e67)[ ](https://doi.org/10.3802/jgo.2025.36.e67)pISSN 2005-0380·eISSN 2005-0399 Original Article The prognostic significance and role of adjuvant therapy for low-volume nodal metastasis in apparent early stage endometrial cancer: an updated systematic review and meta-analysis Yuan Zhuang ,1,* Yue Xu ,1,* Panxia Deng ,1 Shengnan Wang ,2 Huilong Nie ,1 Hua Yang 1 1Department of Gynecology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China 2Sun Yat-sen University, Guangzhou, China Received: Sep 29, 2024 ABSTRACT Revised: Nov 25, 2024 Accepted: Dec 13, 2024 Published online: Feb 10, 2025 Objective: Sentinel lymph node biopsy (SLNB) has improved detection of low-volume node metastasis (LVNM) in endometrial cancer (EC), but its prognostic significance and the need Correspondence to for adjuvant therapy (AT) remain unclear. HuDeiplong Nartmeetof Gynecology, The Fifth Affiliated Methods: A comprehensive search was performed until August 31, 2024 in multiple databases Hospital of SunYat-sen University, 52 East and sources. From 21 studies, 65,228 apparent early-stage EC patients were identified: 370 Meihua Road, New Xiangzhou, Zhuhai 519000, with macrometastases (MAC), 526 with micrometastases (MM), 2,138 with isolated tumor China. cells (ITCs), and 62,194 with negative nodes. Email: [niehlong@mail.sysu.edu.cn](niehlong@mail.sysu.edu.cn Results: Findings)[ Results:](niehlong@mail.sysu.edu.cn Results: Findings)[ Findings](niehlong@mail.sysu.edu.cn Results: Findings) indicated: 1) The MM group had a lower risk of recurrence or progression Hua Yang (R/P) than the MAC group (risk ratio [RR]=0.49; 95% confidence interval [CI]=0.31–0.78; Department of Gynecology, The Fifth Affiliated p=0.002), higher risk than the negative nodes group (RR=2.07; 95% CI=1.59–2.68; p<0.001), Hospital of SunYat-sen University, 52 East and similar risk to the ITC group (RR=0.67; 95% CI=0.44–1.02; p=0.060). 2) The MM group Meihua Road, New Xiangzhou, Zhuhai 519000, had higher 3-year progression-free survival (PFS) (RR=1 .36; 95% CI=1 .21–1.52; p<0 .001) and CEnaial:.[yangh353@mail.sysu.edu.cn](yangh353@mail.sysu.edu.cn overall)[ overall](yangh353@mail.sysu.edu.cn overall) survival (OS) (RR=1.22; 95% CI=1.09–1.37; p<0.001) than the MAC group, similar to the ITC and negative nodes groups. 3) The ITC group had a lower R/P risk and higher 3-year *Yuan Zhuang and Yue Xu contributed equally PFS/OS than the MAC group, similar to the negative nodes group. 4) AT reduced the R/P risk to this work. in the MM group (RR=0.41; 95% CI=0.22–0.76; p=0.005) and increased 3-year OS in the ITC © 2025. Asian Society of Gynecologic group (RR=1.06; 95% CI=1.04–1.08; p<0.001) . Oncology, Korean Society of Gynecologic Conclusion: Early-stage EC with LVNM had better prognostic outcomes than MAC, and AT Oncology, and Japan Society of Gynecologic may improve outcomes of LVNM patients. More evidence from prospective randomized Oncology controlled trials is needed to confirm these findings due to the inherent biases of This is an Open Access article distributed retrospective studies. under the terms of the Creative Commons Attribution Non-Commercial License ([https://](https:// Trial Registration: PROSPERO Identifier: CRD42022364536)[ Trial Registration](https:// Trial Registration: PROSPERO Identifier: CRD42022364536)[: PROSPERO Identifier:](https:// Trial Registration: PROSPERO Identifier: CRD42022364536)[ CRD42022364536](https:// Trial Registration: PROSPERO Identifier: CRD42022364536)[ ](https:// Tria

FAQs

What clinical question does the study address about LVNM in early-stage endometrial cancer?

It evaluates the prognostic significance of low-volume nodal metastasis and whether adjuvant therapy is needed to improve outcomes.

How were patients grouped for analysis in the systematic review and meta-analysis?

Patients were categorized based on nodal status as macrometastases (MAC), micrometastases (MM), isolated tumor cells (ITCs), or negative nodes.

What were the main comparative findings regarding recurrence/progression risk and survival?

The MM group had lower recurrence or progression risk than MAC but higher risk than negative nodes, and survival metrics differed accordingly; AT reduced the recurrence/progression risk in MM and improved overall survival in ITC.

Sep 23, 2026

Uploaded by 4398046744996