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Meta-Analysis
. 2017 Oct 23;12(10):e0186725.
doi: 10.1371/journal.pone.0186725. eCollection 2017.

Neoadjuvant chemotherapy versus primary debulking surgery in advanced epithelial ovarian cancer: A meta-analysis of peri-operative outcome

Lijuan Yang  1 , Bo Zhang  2 , Guangyang Xing  1 , Jingran Du  1 , Bin Yang  1 , Qianqian Yuan  1 , Yongxiu Yang  1
Affiliations
Meta-Analysis

Neoadjuvant chemotherapy versus primary debulking surgery in advanced epithelial ovarian cancer: A meta-analysis of peri-operative outcome

Lijuan Yang et al. PLoS One. .

Expression of concern in

Abstract

Objective: To assess whether neoadjuvant chemotherapy (NACT) is superior to primary debulking surgery (PDS) with regard to optimal cytoreduction, peri-operative morbidity, mortality, and quality of life (QOL) in advanced epithelial ovarian cancer (EOC).

Methods: We searched the PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, Registers of Clinical Trials for randomized controlled trials (RCTs) comparing NACT to PDS in women with Federation of International Gynaecologists and Obstetricians stage Ⅲ-Ⅳ EOC. RevMan 5.3 software was utilized for statistical analysis.

Results: Four RCTs involving 1,607 women with advanced EOC were included. Compared with PDS, NACT provided a higher rate of complete cytoreduction (risk ratio [RR], 1.95; 95% confidence interval [CI], 1.33 to 2.87), optimal cytoreduction (RR: 1.61 [95%CI: 1.05 to 2.47]), but there was no significant difference in residual disease 0-1 cm (p = 0.49). NACT was associated with lower peri-operative morbidity with respect to infection (RR: 0.30 [95% CI: 0.16 to 0.56]), gastrointestinal fistula (RR: 0.24 [95% CI: 0.06 to 0.95]), any grade 3 or 4 adverse event (RR: 0.29 [95% CI: 0.11 to 0.78]), and less post-surgical death within 28 days (RR: 0.14 [95% CI: 0.04 to 0.49]). NACT provided better QOL in terms of fatigue (weight mean difference [WMD], -3.28; [95% CI: -3.99 to -2.57]), role functioning (WMD: 5.29 [95% CI: 4.44 to 6.14]), emotional functioning (WMD: 6.19 [95% CI: 5.57 to 6.82]), and cognitive functioning (WMD: 1.02 [95% CI: 0.43 to 1.61]) at 6-month follow-up compared with PDS.

Conclusions: NACT is associated with superior optimal cytoreduction, lower peri-operative morbidity as well as post-surgical mortality, and better QOL compared to initial surgery in patients with advanced EOC. Future research should focus on improving the efficacy of NACT.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart of literature search.
RCT, randomized controlled trial. NACT, neoadjuvant chemotherapy followed by interval debulking surgery. PDS, primary cytoreductive surgery.
Fig 2
Fig 2. The quality assessment for selected randomized controlled trials.
Low risk of bias (green circles), unclear risk of bias (yellow circles) and high risk of bias (red circles).
Fig 3
Fig 3. Post-operative complications and mortality.
NACT: neoadjuvant chemotherapy followed by interval debulking surgery. PDS: primary cytoreductive surgery.
Fig 4
Fig 4. Fatigue and role functioning at cycle 6 and 6-month follow-up.
NACT, neoadjuvant chemotherapy followed by interval debulking surgery; PDS, primary debulking surgery.
Fig 5
Fig 5. Emotional functioning and cognitive functioning at cycle 6 and 6-month follow-up.
NACT, neoadjuvant chemotherapy followed by interval debulking surgery; PDS, primary debulking surgery.
Fig 6
Fig 6. Extent of residual disease.
NACT: neoadjuvant chemotherapy followed by interval debulking surgery. PDS: primary debulking surgery.
See this image and copyright information in PMC

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