Distant metastasis in patients with cervical cancer: A systematic review and meta‐analysis of incidence rates and common sites

BACKGROUND: Cervical cancer (CC) is a major global health problem, and distant metastasis is a critical determinant of prognosis and survival. However, comprehensive data on the incidence and distribution of non-lymphatic distant organ metastases are limited. OBJECTIVES: This systematic review and meta-analysis aimed to quantify the incidence of non-lymphatic distant organ metastasis in patients with CC and to identify the most commonly reported organ sites. SEARCH STRATEGY: A systematic search was conducted across PubMed/Medline, Web of Science, Scopus, and Embase from inception to March 1, 2025. To supplement the database searches and minimize publication bias, we also searched Google Scholar to identify potentially relevant studies. Reference lists of included studies were screened for additional eligible articles. SELECTION CRITERIA: Observational studies reporting the incidence or distribution of non-lymphatic distant organ metastases (bone, brain, liver, and lung) in CC cohorts were included. Case reports, reviews, and studies restricted exclusively to patients with established stage IVB/M1 disease at presentation were excluded, to avoid overrepresenting patients with already documented metastatic disease. DATA COLLECTION AND ANALYSIS: statistic. MAIN RESULTS: A total of 42 studies, comprising 238 387 patients, were included in the analysis. The pooled incidence rate of metastasis was 2.91 per 100 CC patients (95% CI: 2.84-2.97). Regional analysis showed that the Western Pacific region had the highest pooled incidence at 4.66 per 100 patients (95% CI: 4.52-4.79), followed by the European region at 2.50 per 100 patients (95% CI: 2.09-2.97) and the Americas at 1.68 per 100 patients (95% CI: 1.61-1.75). Among site-specific non-lymphatic distant organ metastases, bone was the most common, with a pooled incidence of 3.67 per 100 patients (95% CI: 2.37-5.06), followed by lung metastases (3.00 per 100 patients, 95% CI: 2.13-4.21), brain metastases (1.83 per 100 patients, 95% CI: 0.91-2.75), and liver metastases (1.70 per 100 patients, 95% CI: 0.45-2.95). CONCLUSION: Our findings indicate that the incidence of distant metastasis varies substantially by anatomic site, with bone and lung being the most common locations. However, due to large heterogeneity, these findings should be interpreted as descriptive trends rather than precise estimates. The predominance of bone and lung metastases emphasizes the need for enhanced clinical awareness regarding these organs and underscores the importance of standardized prospective studies to validate these patterns and guide surveillance strategies.