The role of neoadjuvant chemotherapy followed by interval debulking surgery in advanced ovarian cancer: a systematic review and meta-analysis of randomized controlled trials and observational studies
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Meng Qin1, Ying Jin1, Li Ma2, Yan-Yan Zhang1 and Ling-Ya Pan1
1Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
2Department of Interventional Radiology and Vascular Surgery, Taiyuan Center Hospital, Taiyuan 030009, China
Ying Jin, email: email@example.com
Keywords: neoadjuvant chemotherapy; debulking surgery; ovarian cancer; survival
Received: July 15, 2017 Accepted: November 15, 2017 Published: December 27, 2017
Objective: We aimed to performed a meta-analysis and systematic review on the role of neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) in advanced ovarian cancer (AOC) patients.
Materials and Methods: We searched PubMed, EMBASE, and the Cochrane Library for relevant articles. All statistical analyses were performed in Review Manager 5.3.5.
Results: In two randomized controlled trials (RCTs), there was no significant difference in overall survival (OS) (HR = 0.93, 95% CI: 0.81–1.06) or progression-free survival (PFS) (HR = 0.97, 95% CI: 0.86–1.09). Few adverse events (HR = 0.37, 95% CI: 0.19–0.72) and a high optimal debulking surgery rate (HR = 1.69, 95% CI: 1.50–1.91) were observed with NACT. In 22 observational studies, primary debulking surgery (PDS) yielded better OS (HR = 1.38, 95% CI: 1.19–1.60) but not progression-free survival (PFS) (HR = 1.03, 95% CI: 0.86–1.23). An increased optimal cytoreduction rate (HR = 1.17, 95% CI: 1.12–1.22) was observed with NACT. Irrespective of the degree of residual disease, OS was longer in the PDS group than that in the NACT group. Patients with FIGO stage III (HR = 1.43, 95% CI: 1.05–1.95) and IV (HR = 1.14, 95% CI: 1.06–1.23) disease had better survival with PDS.
Conclusions: Treatment with NACT-IDS improves perioperative outcomes and optimal cytoreduction rates, but it may not improve OS. NACT-IDS is not inferior to PDS-CT in terms of survival outcomes in selected AOC patients. Future studies should focus on candidate selection for NACT.
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