A meta-analysis of residual disease and survival in stage III and IV carcinoma of the ovary

Abstract

A meta-analysis of retrospective studies was performed to determine the value of cytoreductive surgery separately for Stage III and IV ovarian cancer.

Design: A literature search and personal communications were used to identify studies reporting patient numbers and survival data at 2 years and/or 5 years in patients with no residual, < = 2 cm and > 2 cm residual disease after surgery for Stage III and IV ovarian cancer. An odds ratio (OR) with 95% confidence intervals was performed on the data using the Cochran-Mantel-Haeszel procedure.

Results: The results show a survival benefit for patients with nil and < = 2 cm residual disease after surgery for both stage III and IV disease when compared to patient left with tumor masses > 2 cm. For Stage III patients the OR was 3.98 (3.31 to 4.79) at 2 years and 5.51 (4.40 to 6.90) at 5 years, indicating with 95% confidence that those with < = 2 cm residual tumor survived longer. When comparing nil and < = 2 cm residual disease survival is better for the group with nil residual with OR 3.37 (2.17 to 5.22) at 2 year and OR 4.35 (2.87 to 6.61) at 5 years. Optimal cytoreduction was also beneficial in Stage IV with OR 4.94 (2.55 to 9.57). Although it appears that maximum surgical effort is justified for stage III as well as Stage IV ovarian cancer, it must be remembered that no prospective, randomized trials have been performed.

Conclusion: Optimal cytoreductive surgery appears to benefit the patient with ovarian cancer, but no data from prospective, randomized trials are available and tumor biology is not assessed. Very few studies report survival data based on the amount of residual disease in the separate FIGO stages. There is a need for a single, large database reporting all known variables for each patient.