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. 2017 Dec 27;9(9):8614-8628.
doi: 10.18632/oncotarget.23808. eCollection 2018 Feb 2.

The role of neoadjuvant chemotherapy followed by interval debulking surgery in advanced ovarian cancer: a systematic review and meta-analysis of randomized controlled trials and observational studies

Meng Qin  1 , Ying Jin  1 , Li Ma  2 , Yan-Yan Zhang  1 , Ling-Ya Pan  1
Affiliations

The role of neoadjuvant chemotherapy followed by interval debulking surgery in advanced ovarian cancer: a systematic review and meta-analysis of randomized controlled trials and observational studies

Meng Qin et al. Oncotarget. .

Abstract

Objective: We aimed to performed a meta-analysis and systematic review on the role of neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) in advanced ovarian cancer (AOC) patients.

Materials and methods: We searched PubMed, EMBASE, and the Cochrane Library for relevant articles. All statistical analyses were performed in Review Manager 5.3.5.

Results: In two randomized controlled trials (RCTs), there was no significant difference in overall survival (OS) (HR = 0.93, 95% CI: 0.81-1.06) or progression-free survival (PFS) (HR = 0.97, 95% CI: 0.86-1.09). Few adverse events (HR = 0.37, 95% CI: 0.19-0.72) and a high optimal debulking surgery rate (HR = 1.69, 95% CI: 1.50-1.91) were observed with NACT. In 22 observational studies, primary debulking surgery (PDS) yielded better OS (HR = 1.38, 95% CI: 1.19-1.60) but not progression-free survival (PFS) (HR = 1.03, 95% CI: 0.86-1.23). An increased optimal cytoreduction rate (HR = 1.17, 95% CI: 1.12-1.22) was observed with NACT. Irrespective of the degree of residual disease, OS was longer in the PDS group than that in the NACT group. Patients with FIGO stage III (HR = 1.43, 95% CI: 1.05-1.95) and IV (HR = 1.14, 95% CI: 1.06-1.23) disease had better survival with PDS.

Conclusions: Treatment with NACT-IDS improves perioperative outcomes and optimal cytoreduction rates, but it may not improve OS. NACT-IDS is not inferior to PDS-CT in terms of survival outcomes in selected AOC patients. Future studies should focus on candidate selection for NACT.

Keywords: debulking surgery; neoadjuvant chemotherapy; ovarian cancer; survival.

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Conflict of interest statement

CONFLICTS OF INTEREST All authors declare that they have no competing interests.

Figures

Figure 1
Figure 1. Flow diagram of trial selection
Figure 2
Figure 2. Risk of bias summary for the RCTs
Figure 3
Figure 3. Forest plot of OS and PFS in RCTs
Figure 4
Figure 4. Forest plot of OS in observational studies
Figure 5
Figure 5. Forest plot of PFS in observational studies
Figure 6
Figure 6. Forest plot of adverse events in RCTs
Figure 7
Figure 7. Forest plot of the optimal debulking rate in RCTs and observational studies
Figure 8
Figure 8. Forest plot of OS of patients with different degrees of residual disease in the observational studies
Figure 9
Figure 9. Forest plot of OS of patients with FIGO stage III versus stage IV disease in observational studies
Figure 10
Figure 10. Funnel plot of OS in observational studies
See this image and copyright information in PMC

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