The survival outcome and complication of secondary cytoreductive surgery plus chemotherapy in recurrent ovarian cancer: a systematic review and meta-analysis

Abstract

Objective The aim of this meta-analysis was to assess the effectiveness and safety of secondary cytoreductive surgery plus chemotherapy (SCS + CT) in recurrent ovarian cancer (ROC). Our secondary purpose was to analyze whether patients could benefit from complete resection. Methods We searched EMBASE, MEDLINE, the Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials, from inception to April 2021. We used appropriate scales to assess the risk of bias. Data from included studies that reported median PFS or OS were weighted by individual study sample size, and aggregated for meta-analysis. We calculated the pooled proportion of complications within 30 days after surgery. Results We identified 13 articles, including three RCTs and ten retrospective cohort studies. A total of 4572 patients were included, of which 916 patients achieved complete resection, and all patients were comparable at baseline. Compared with chemotherapy alone, SCS + CT significantly improved the PFS (HR = 0.54, 95% CI: 0.43–0.67) and OS (HR = 0.60, 95% CI: 0.44–0.81). Contrary to the results of cohort studies, the meta-analysis of RCTs showed that SCS + CT could not bring OS benefits (HR = 0.93, 95% CI: 0.66–1.3). The subgroup analysis showed the prognostic importance of complete resection. Compared with chemotherapy alone, complete resection was associated with longer PFS (HR = 0.53, 95% CI: 0.45–0.61) and OS (HR = 0.56, 95% CI: 0.39–0.81), while incomplete resection had no survival benefit. Additionally, complete resection could maximize survival benefit compared with incomplete resection (HR = 0.56, 95% CI: 0.46–0.69; HR = 0.61, 95% CI: 0.50–0.75). The pooled proportion for complications at 30 days was 21% (95% CI: 0.12–0.30), and there was no statistical difference in chemotherapy toxicity between the two groups. Conclusion The review indicated that SCS + CT based regimens was correlated with better clinical prognosis for patients with recurrent ovarian cancer, but the interpretation of OS should be cautious. The meta-analysis emphasizes the importance of complete resection, suggesting that the potential benefits of prolonging survival may outweigh the disadvantages of any short-term complications associated with surgery.

The efficacy and safety of angiogenesis inhibitors for recurrent ovarian cancer: a meta‑analysis

“…Oncologists continue to face a formidable challenge in treating OC. Recurrent OC is almost always incurable, even when patients receive multiple lines of platinum and non-platinum therapy for advanced disease [ 20 ]. A promising novel therapeutic aimed at the tumor microenvironment has been proposed.…”

Surgery in Recurrent Ovarian Cancer: A Meta-Analysis

“…About 80% of patients will relapse despite chemotherapy treatment (CHT) and targeted maintenance therapy [ 2 ]. The treatment of recurrent ovarian cancer (ROC) is thus a significant clinical challenge [ 3 ].…”

“…The standard treatment for ROC patients includes intravenous CHT, chosen based on platinum sensitivity [ 4 ]. It is important to clarify the role of secondary cytoreductive surgery (SCS) in these patients and the choice of a surgical approach [ 1 , 2 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ].…”

Effects of Icodextrin Solution (Adept®) on Ovarian Cancer Cell Proliferation in an In Vitro Model

“…These adhesions can lead to postoperative bowel obstructions and increase morbidity [ 2 ]. Moreover, adhesions can complicate second surgical procedures, which are frequently necessary in ovarian cancer due to their high recurrence rate [ 3 , 4 ]. Thus, the need to prevent intra-abdominal adhesions is an important issue.…”