869 Surgical vs imaging staging for non-early stage cervical cancer: systematic review and meta-analysis

Introduction/Background To compare surgical vs imaging staging for locally advanced/advanced-stage cervical cancer in terms of survival outcomes as well as to summarize evidence regarding diagnostic accuracy of various imaging methods. Methodology A systematic review and meta-analysis was performed. Included studies should have as primary outcome the comparison between surgical and imaging staging for locally advanced/advanced-stage cervical cancer patients. Furthermore, studies reporting on diagnostic accuracy of imaging modalities based on pathological outcome of surgical staging were also set in the scope of the present analysis. All types of studies were included. Primary outcomes of the study were overall and disease-free survival. Secondary outcomes concerned diagnostic accuracy measures of any imaging modality. Results Nine articles were finally selected for analysis of primary outcomes and 13 articles for secondary outcomes. Risk of bias was low for two studies, serious for four studies and critical for the rest reporting on primary outcomes. No significant difference was observed in any of the reported survival outcomes. Overall recurrence rate was comparable for both groups, namely 44.9% for surgical staging vs. 41.3% for imaging staging (RR: 1.07, 95% CI: 0.81–1.40, 4 studies, 1,322 patients). Overall death rate was lower for surgical staging (39.6% vs. 45.2% for imaging staging) without the difference being significantly different (RR: 0.85, 2 studies, 3,225 patients). Overall and disease free survival adjusted hazard ratios, 5-year OS and DFS were comparable within two groups. Regarding secondary outcomes, adjusted negative predictive value was 86.8%, adjusted false-negative rate 12.9%, while adjusted sensitivity 51.2% and adjusted false positive rate 25.4%. The overall quality of the evidence was very low for all primary outcomes. Conclusion Even if surgical and imaging staging could be comparable in terms of survival outcomes, data analyzed presented a low quality, high risk of bias and high heterogeneity. Disclosures Authors have nothing to disclose