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Meta-Analysis
. 2016 Nov 2:6:35914.
doi: 10.1038/srep35914.

Neoadjuvant chemotherapy for Patients with advanced epithelial ovarian cancer: A Meta-Analysis

Long-Jia Zeng  1 , Chun-Lin Xiang  2 , Yi-Zhen Gong  3 , Yan Kuang  1 , Fang-Fang Lu  1 , Su-Yi Yi  1 , Yue Zhang  1 , Meng Liao  1
Affiliations
Meta-Analysis

Neoadjuvant chemotherapy for Patients with advanced epithelial ovarian cancer: A Meta-Analysis

Long-Jia Zeng et al. Sci Rep. .

Abstract

The value of neoadjuvant chemotherapy (NAC) has not yet been fully defined. We aimed to systematically evaluate the influence of neoadjuvant chemotherapy (NAC) on survival and complete cytoreduction after debulking surgery in advanced epithelial ovarian cancer (AEOC) patients. We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for the randomized controlled trials (RCTs) comparing NAC and primary debulking surgery (PDS) in AEOC patients. The last search date is February 25, 2016. Cochrane systematic evaluation was used to evaluate bias risk of included studies. RevMan 5.3 software was used for statistical analysis. A total of 4 RCTs involving 1922 patients were included. Compared with PDS, NAC may contribute to the completeness of debulking removal [no residual disease (RR: 2.37; 95%CI: 1.94-2.91; P<0.00001), residual disease ≤1 cm (RR: 1.28; 95%CI: 1.04-1.57; P = 0.02), optimal cytoreduction rate (RR: 1.76; 95%CI: 1.57-1.98; P<0.00001)], but there were no significant differences in both groups with regard to overall survival (HR: 0.94; 95%Cl: 0.81-1.08; P = 0.38) and progression-free survival (HR: 0.89; 95%Cl: 0.77-1.03; P = 0.12). This meta-analysis indicates that the higher rate of optimal debulking made NAC more favorable as a treatment option for AEOC patients with non-inferior survival compared with PDS.

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Figures

Figure 1
Figure 1. Flow diagram of literature search.
RCT, randomized controlled trial.
Figure 2
Figure 2. Assessment of quality of selected RCTs.
Low risk of bias (green circles), unclear risk of bias (yellow circles) and high risk of bias (red circles).
Figure 3
Figure 3. Forest plot for overall survival.
NAC, neoadjuvant chemotherapy followed by interval debulking surgery; PDS, primary cytoreductive surgery followed by systemic chemotherapy.
Figure 4
Figure 4. Forest plot for progression-free survival.
NAC, neoadjuvant chemotherapy followed by interval debulking surgery; PDS, primary cytoreductive surgery followed by systemic chemotherapy.
Figure 5
Figure 5. Forest plot for extent of surgical debulking.
The definition of optimal cytoreductive surgery is residual tumor diameter ≤1 cm or no residual disease after debulking surgery; NAC, neoadjuvant chemotherapy followed by interval debulking surgery; PDS, primary cytoreductive surgery followed by systemic chemotherapy.
See this image and copyright information in PMC

References

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