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Review
. 2023 Nov 20;13(22):3484.
doi: 10.3390/diagnostics13223484.

Prognosis Following Surgery for Recurrent Ovarian Cancer and Diagnostic Criteria Predictive of Cytoreduction Success: A Systematic Review and Meta-Analysis

Faiza Gaba  1   2 , Oleg Blyuss  3   4 , Dhivya Chandrasekaran  5 , Nicolò Bizzarri  6 , Basel Refky  7 , Desmond Barton  1 , Thomas Ind  1 , Marielle Nobbenhuis  1 , John Butler  1 , Owen Heath  1 , Arjun Jeyarajah  8 , Elly Brockbank  8 , Alexandra Lawrence  8 , Ranjit Manchanda  3   8 , James Dilley  8 , Saurabh Phadnis  8 , On Behalf Of The Go Soar Collaborative
Affiliations
Review

Prognosis Following Surgery for Recurrent Ovarian Cancer and Diagnostic Criteria Predictive of Cytoreduction Success: A Systematic Review and Meta-Analysis

Faiza Gaba et al. Diagnostics (Basel). .

Abstract

For women achieving clinical remission after the completion of initial treatment for epithelial ovarian cancer, 80% with advanced-stage disease will develop recurrence. However, the standard treatment of women with recurrent platinum-sensitive diseases remains poorly defined. Secondary (SCS), tertiary (TCS) or quaternary (QCS) cytoreduction surgery for recurrence has been suggested to be associated with increased overall survival (OS). We searched five databases for studies reporting death rate, OS, cytoreduction rates, post-operative morbidity/mortality and diagnostic models predicting complete cytoreduction in a platinum-sensitive disease recurrence setting. Death rates calculated from raw data were pooled based on a random-effects model. Meta-regression/linear regression was performed to explore the role of complete or optimal cytoreduction as a moderator. Pooled death rates were 45%, 51%, 66% for SCS, TCS and QCS, respectively. Median OS for optimal cytoreduction ranged from 16-91, 24-99 and 39-135 months for SCS, TCS and QCS, respectively. Every 10% increase in complete cytoreduction rates at SCS corresponds to a 7% increase in median OS. Complete cytoreduction rates ranged from 9-100%, 35-90% and 33-100% for SCS, TCS and QCS, respectively. Major post-operative thirty-day morbidity was reported to range from 0-47%, 13-33% and 15-29% for SCS, TCS and QCS, respectively. Thirty-day post-operative mortality was 0-6%, 0-3% and 0-2% for SCS, TCS and QCS, respectively. There were two externally validated diagnostic models predicting complete cytoreduction at SCS, but none for TCS and QCS. In conclusion, our data confirm that maximal effort higher order cytoreductive surgery resulting in complete cytoreduction can improve survival.

Keywords: diagnostics; ovarian cancer; prognosis; recurrence; surgery.

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Conflict of interest statement

F.G. declares funding from The NHS Grampian Endowment Fund, Medtronic and the British Gynaecological Cancer Society outside of this work and an honorarium from Astra Zeneca. All other authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Forest plot of the death rate for secondary cytoreduction surgery [4,6,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,29,30,31,32,33,34,35,37,38,39,40,41,42,43,71].
Figure 2
Figure 2
Forest plot of the death rate for tertiary cytoreduction surgery [72,73,76,78,79].
Figure 3
Figure 3
Forest plot of the death rate for quaternary cytoreduction surgery [80,83].
See this image and copyright information in PMC

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