Secondary Cytoreductive Surgery in Platinum Sensitive Recurrent Ovarian Cancer: A Meta-Analysis

Abstract

Background: The survival impact of secondary cytoreductive surgery in platinum-sensitive recurrent ovarian cancer patients was studied. Methods: Published studies from 1983 to 2020 that were in accordance with our inclusion criteria from MEDLINE, EMBASE, and Cochrane library were identified. To integrate the effect size of single-arm studies, meta-analysis was performed using death rate as a primary outcome. The effect of complete cytoreduction and optimal cytoreduction on survival was evaluated using meta-regression. The pooled death rate was presented with a 95% confidence interval (CI). The publication bias was evaluated with the funnel plot and egger’s test, and sensitivity analysis were performed. To overcome missing death rates, the linear regression model was performed on log-transformed median overall survival time using the study size as a weight. Findings: Of the 75 eligible studies that satisfied the inclusion criteria, 33 studies that reported death rates with 2,261 patients were used for meta-analysis. Following a heterogeneity test, we considered a random effect model because the p-value of Cochrane Q test was less than 0·001, and Higgins’s I 2 statistics was 91%, indicating considerable heterogeneity. The pooled death rate was 0·440 (95% CI, 0·374-0·505), and both the complete and optimal cytoreductions were associated with better survival outcomes as significant moderators in the meta-regression model (p <0·001 and p=0·010, respectively). Although fourteen studies were located outside the funnel plot, sensitivity analysis showed similar results, and egger’s test also showed no significant publication bias (p=0·733). In the linear regression model based on 55 studies reporting median overall survival time, median overall survival time increases by 8·619% and 6·531% when the proportion of complete and optimal cytoreduction increases by 10% after adjusting other variables. Interpretation: Secondary cytoreductive surgery without postoperative residual disease in more recent publications is associated with increased overall survival in platinum-sensitive recurrent ovarian cancer. Funding: The study was funded by the National Cancer Centre, Korea (NCC2110790). Declaration of Interest: All other authors declare no competing interests.