J Gynecol Oncol.  2020 Mar;31(2):e12. 10.3802/jgo.2020.31.e12.

Efficacy and safety of neoadjuvant chemotherapy versus primary debulking surgery in patients with ovarian cancer: a meta-analysis

• Lv X
• Cui S
• Zhang X
• Ren C

• KMID: 2470865
• DOI: http://doi.org/10.3802/jgo.2020.31.e12

Abstract

OBJECTIVE
Neoadjuvant chemotherapy (NACT) for the treatment of epithelial ovarian cancer (EOC) has remained controversial. This meta-analysis was performed to systematically assess the efficacy and safety of NACT versus primary debulking surgery (PDS) in patients with EOC.
METHODS
PubMed, Embase, ClinicalTrials.gov, and Cochrane Library were queried to assess the therapeutic value of NACT versus PDS in EOC. Electronic databases were queried by using the keywords "ovarian cancer/neoplasms", "primary debulking surgery", and "neoadjuvant chemotherapy".
RESULTS
The available trials were pooled, and hazard ratios (HRs), relative risk ratios (RRs) and associated 95% confidence intervals (95% CIs) were determined. Sixteen trials involving 57,450 participants with EOC (NACT, 9,475; PDS, 47,975) were evaluated. We found that NACT resulted in markedly decreased overall survival than PDS in patients with EOC (HR=1.30; 95% CI=1.13-1.49; heterogeneity: p<0.001, ²=82.7%). Furthermore, our results demonstrated that the NACT group displayed increased completeness of debulking removal (RR=1.69, 95% CI=1.32-2.17; heterogeneity: p<0.001, ²=81.9%), and reduced risk of postsurgical death (RR=0.18, 95% CI=0.06-0.51; heterogeneity: p=0.698, ²=0%) and major infection (RR=0.29, 95% CI=0.17-0.51; heterogeneity: p=0.777, ²=0%) compared with patients administered PDS.
CONCLUSIONS
This meta-analysis indicated that NACT results in increased completeness of debulking removal, and reduced risk of postsurgical death and major infection compared with PDS, while PDS is associated with improved survival in comparison with NACT in EOC patients. TRIAL REGISTRATION: PROSPERO Identifier: CRD42019120625

Keyword

Neoadjuvant Therapy; Debulking Surgical Procedure; Epithelial Ovarian Cancer; Meta-Analysis

MeSH Terms

Cytoreduction Surgical Procedures
Drug Therapy*
Humans
Neoadjuvant Therapy
Odds Ratio
Ovarian Neoplasms*
Population Characteristics

Figure

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  Fig. 1. Flow diagram of study inclusion.

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  Fig. 3. Post-operative complications and mortality. (A) Postsurgical death, (B) Major infections, and (C) Wound complications. CI, confidence interval; NACT, neoadjuvant chemotherapy; PDS, primary debulking surgery; RR, risk ratio.

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  Fig. 2. Forest plots for survival and extent of surgical debulking. (A) OS, (B) PFS, (C) Completeness of debulking removal, and (D) Residual disease ≤1 cm. CI, confidence interval; HR, hazard ratio; NACT, neoadjuvant chemotherapy; PDS, primary debulking surgery; RR, risk ratio.

Reference

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