Abstract
The value of neoadjuvant chemotherapy (NAC) has not yet been fully defined. We aimed to systematically evaluate the influence of neoadjuvant chemotherapy (NAC) on survival and complete cytoreduction after debulking surgery in advanced epithelial ovarian cancer (AEOC) patients. We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for the randomized controlled trials (RCTs) comparing NAC and primary debulking surgery (PDS) in AEOC patients. The last search date is February 25, 2016. Cochrane systematic evaluation was used to evaluate bias risk of included studies. RevMan 5.3 software was used for statistical analysis. A total of 4 RCTs involving 1922 patients were included. Compared with PDS, NAC may contribute to the completeness of debulking removal [no residual disease (RR: 2.37; 95%CI: 1.94–2.91; P<0.00001), residual disease ≤1 cm (RR: 1.28; 95%CI: 1.04–1.57; P = 0.02), optimal cytoreduction rate (RR: 1.76; 95%CI: 1.57–1.98; P<0.00001)], but there were no significant differences in both groups with regard to overall survival (HR: 0.94; 95%Cl: 0.81–1.08; P = 0.38) and progression-free survival (HR: 0.89; 95%Cl: 0.77–1.03; P = 0.12). This meta-analysis indicates that the higher rate of optimal debulking made NAC more favorable as a treatment option for AEOC patients with non-inferior survival compared with PDS.
Highlights
The standard of care for advanced epithelial ovarian cancer (AEOC) has been primary cytoreductive surgery (PDS) followed by systemic chemotherapy
These findings correspond with the data from Vergote et al.[2], but not of Van Der Burg et al.[5], in which patients with AEOC achieved longer survival with neoadjuvant chemotherapy (NAC) followed by interval debulking surgery (IDS) compared to primary debulking surgery (PDS)
We performed a meta-analysis of 4 randomized controlled trials (RCTs) to systematically evaluate the influence of NAC on survival and complete cytoreduction after debulking surgery in AEOC patients
Summary
The standard of care for advanced epithelial ovarian cancer (AEOC) has been primary cytoreductive surgery (PDS) followed by systemic chemotherapy. Kehoe et al.[1] published a randomized phase III trial comparing NAC versus PDS in patients with AEOC, which showed equivalent survival in these patients, though NAC was associated with fewer complications and lower treatment-related mortality after IDS. These findings correspond with the data from Vergote et al.[2], but not of Van Der Burg et al.[5], in which patients with AEOC achieved longer survival with NAC followed by IDS compared to PDS. The present meta-analysis was restricted to RCTs in order to eliminate selection bias, and overcome the limitation of retrospective studies
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