Abstract
OBJECTIVE: This study aimed to assess the prognosis of endometrial cancer (EC) patients after sentinel lymph node biopsy (SLNB) or lymph node dissection (LND) alone. METHODS: EMBASE, PUBMED, COCHRANE, and WEB of SCIENCE were thoroughly searched for relevant articles until October 2024. The outcomes of interest encompassed overall survival (OS), progression-free survival (PFS), and disease-specific survival (DSS). Data analysis was made in STATA 18.0. The Newcastle-Ottawa Scale tool was leveraged to appraise study quality. RESULTS: 13 studies were included, involving 36621 EC patients. No difference was revealed in OS between SLNB and LND (HR=1.04, 95%CI: 0.80-1.33; P=0.789). In subgroup analyses, the SLNB group from survival curves had worse OS (HR=1.63, 95%CI: 1.04-2.56; P=0.035); the SLNB group with intermediate- to high-risk EC had better OS (HR=0.20, 95%CI: 0.08-0.49; P<0.001). No difference was revealed in PFS between SLNB and LND (HR=0.99, 95%CI: 0.76-1.28; P=0.927). SLNB had better PFS in Asia (HR=0.44, 95% CI: 0.20-0.98, P=0.046) and stage I-III EC (HR=0.46, 95% CI: 0.24-0.89; P=0.021). No statistical difference was found in DSS (HR=3.18, 95%CI: 0.91-11.07; P=0.069). CONCLUSION: SLNB is an effective alternative to conventional LND in either low- or intermediate-high-risk EC patients. However, due to the retrospective nature of most included studies and the limited data on high-risk patients, further prospective randomized controlled trials are warranted to validate these findings. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO, identifier CRD42024489323.