Efficacy and Safety of Platinum-Based Chemotherapy for Ovarian Cancer During Pregnancy: A Systematic Review and Meta-Analysis

Abstract

Introduction: Based on the available data on ovarian cancer during pregnancy, we performed a review and meta-analysis to evaluate the efficacy and safety of platinum-based chemotherapy against ovarian cancer during pregnancy.

Methods: We systematically searched three databases including the PubMed, Embase, and Cochrane Library databases for articles published from January 1986 to December 2020 using the following terms: "ovarian tumors OR ovarian carcinoma OR adnexal masses OR ovarian cancer" AND "pregnancy" AND "chemotherapy." Two authors (Yaping Pei and Yuanfeng Gou) independently searched the literature and extracted data from each eligible study. The outcome measures were overall survival (OS) and progression-free survival (PFS). The OS and PFS of all patients were estimated by Kaplan-Meier survival curves and log-rank tests.

Results: A total of 43 studies including 55 cases of ovarian cancer during pregnancy were selected. Forty-eight patients were comprehensively staged using the International Federation of Gynecology and Obstetrics (FIGO) staging system. Twenty-six of the 48 patients (54.17%) were diagnosed with early-stage disease, while the remaining had advanced stages (II, III, and IV). The mean age at diagnosis was 29.31 years. The majority of patients in this meta-analysis were diagnosed at a mean gestational age of 16.05 weeks. The mean GA at chemotherapy administration was 17.42 weeks. Overall, 55 women gave birth to 56 newborns, including a pair of twins. At the end of follow-up (median 10 months, range 0-73 months), all the children were healthy, except for one child who died 5 days after delivery due to a congenital abnormality. During 2-204 months of follow-up, there were five cases of recurrence, with no evidence of recurrence in the remaining cases. Unfortunately, one patient died 29 months after diagnosis. Neither median overall survival nor median progression-free survival was obtained.

Conclusion: Platinum-based chemotherapy may be a good choice for pregnant women with ovarian cancer who want to continue their pregnancy.

Keywords: Chemotherapy; Meta-analysis; Ovarian cancer; Pregnancy.

Fig. 1

Flow chart of study selection in this meta-analysis

Fig. 2

Kaplan–Meier survival curves. a Overall survival, n = 49. b Progression-free survival, n = 46

Fig. 3

Kaplan–Meier survival curves by FIGO stage. a Overall survival, I, n = 24; II–IV, n = 21. b Progression-free survival, I, n = 22; II–IV, n = 20

Fig. 4

Kaplan–Meier survival curves by pathological type. a Overall survival: epithelial, n = 25; non-epithelial, n = 22. b Progression-free survival: epithelial, n = 24; non-epithelial, n = 22

Fig. 5

Kaplan–Meier survival curves by FIGO stage. a Overall survival: platinum alone, n = 6; platinum combination, n = 36. b Progression-free survival: platinum alone, n = 6; platinum combination, n = 34