A meta-analysis: neoadjuvant chemotherapy versus primary surgery in ovarian carcinoma FIGO stageIII and IV

World Journal of Surgical Oncology, Oct 2013

Background The purpose of the current study is to analyze the existing data comparing neoadjuvant chemotherapy with primary debulking surgery (PDS) in patients with advanced ovarian carcinoma. Methods Patients with stage IIIC and IV ovarian cancer were identified from articles in Medline, PubMed, Cochrane Library, and EMBASE database (1989 to February 2013). Two authors independently extracted the data. To assess the risk of bias of included literatures, Cochrane Collaboration’s risk of bias tool was used. Meta-analysis on literatures was conducted by using RevMan 5.2 software. Results Two high-quality randomized controlled trials (RCTs) met the inclusion criteria. These multicenter trials randomized 1,220 women with stage IIIc/IV ovarian cancer to NACT or PDS followed by chemotherapy. There were no significant differences between the study groups with regard to overall survival (OS) (1,120 women; HR 0.98; 95% CI 0.85 to 1.14) or progression-free survival (PFS) (1,120 women; HR 1.03; 95% CI 0.91 to 1.16). Conclusion There was no statistical difference in median OS and PFS between the two treatment groups. With regard to selecting who will benefit from NACT, treatment should be tailored to the patient and should take into account respectability, age, histology, stage, and performance status.

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A meta-analysis: neoadjuvant chemotherapy versus primary surgery in ovarian carcinoma FIGO stageIII and IV

Ma Dai-yuan 0 Tan Bang-xian 0 Li Xian-fu 0 Zhou Ye-qin 0 Cai Hong-Wei 0 0 Department of Oncology, the First Affiliated Hospital of North Sichuan Medical College , Nanchong 637000 , People's Republic of China Background: The purpose of the current study is to analyze the existing data comparing neoadjuvant chemotherapy with primary debulking surgery (PDS) in patients with advanced ovarian carcinoma. Methods: Patients with stage IIIC and IV ovarian cancer were identified from articles in Medline, PubMed, Cochrane Library, and EMBASE database (1989 to February 2013). Two authors independently extracted the data. To assess the risk of bias of included literatures, Cochrane Collaboration's risk of bias tool was used. Meta-analysis on literatures was conducted by using RevMan 5.2 software. Results: Two high-quality randomized controlled trials (RCTs) met the inclusion criteria. These multicenter trials randomized 1,220 women with stage IIIc/IV ovarian cancer to NACT or PDS followed by chemotherapy. There were no significant differences between the study groups with regard to overall survival (OS) (1,120 women; HR 0.98; 95% CI 0.85 to 1.14) or progression-free survival (PFS) (1,120 women; HR 1.03; 95% CI 0.91 to 1.16). Conclusion: There was no statistical difference in median OS and PFS between the two treatment groups. With regard to selecting who will benefit from NACT, treatment should be tailored to the patient and should take into account respectability, age, histology, stage, and performance status. - Review Introduction An estimated 22,280 new cases of ovarian cancer are expected in the US in 2012 [1]. Ovarian cancer causes more deaths than any other cancer of the female reproductive system [1]. In most patients with ovarian carcinoma, the disease is diagnosed at an advanced stage and they usually have a very poor prognosis [2]. Primary surgical treatment of ovarian cancer has advantages in terms of diagnosis, staging, and tumor debulking [3,4]. The value of debulking surgery is well established in FIGO stage III epithelial ovarian cancer [5]. Most women will have widespread disease, therefore surgery alone does not cure the disease. Neoadjuvant chemotherapy (NACT) prior to surgical debulking proposes to increase the proportion of patients who may be optimally cytoreduced, while decreasing surgical morbidity and mortality [6]. Several retrospective studies have shown that there was no difference in overall survival (OS) or progression-free survival (PFS) for patients with advanced ovarian cancer treated with neoadjuvant chemotherapy compared with primary debulking surgery (PDS) [7-11]. However, the result of a meta-analysis of Bristow and Chi [12] involving 835 patients suggested that NACT, compared with PDS, was associated with a worse OS and it was suggested that the definitive operative intervention should be undertaken as early in the treatment program as possible. But a more recent meta-analysis [13] of multiply central randomized trials concluded that survival was similar in patients treated with NACT followed by interval debulking surgery compared to primary debulking followed by chemotherapy and criticized the meta-analysis of Bristow and Chi [12]. Since randomized controlled trials (RCTs) are the gold standard of evidence-based medical research, we hope that a review of randomized evidence may clarify what the benefits and risks are of using NACT for women with advanced ovarian cancer, compared with the standard treatment of PDS [13,14]. The purpose of the current study is to analyze the existing data comparing NACT with PDS in patients with advanced ovarian carcinoma which included more RCTs. Methods Literature research We undertook computerized literature searches of MEDLINE, PubMed, Cochrane Library, and EMBASE databases, from their inception to February 2013. Search terms were ovarian carcinoma, ovarian cancer, neoadjuvant chemotherapy, and primary surgery. These terms were used in different combinations with each other. Appropriate references cited by the retrieved studies were also identified. Study selection Publications were selected for initial review if the research subjects were patients with International Federation of Gynecology and Obstetrics (FIGO) stage III and IV ovarian cancer who underwent NACT and PDS. In order to fully exclude the possibility of selection bias, only RCTs of NACT versus PDS were permitted. Duplicate publications or data were carefully reviewed by two of the authors and the larger (primary decision) or the most recent publication was included. Data on trial size, patient characteristics (age, sex, AF duration, left ventricular size, left ventricular ejection fraction, and so on), procedure duration, and patient number of sinus rhythm maintenance without anti-arrhythmic drugs were extracted. Included studies were reviewed based on randomization, allocation concealment, blinding, loss of follow-ups, and ITT. The truths of the studies were divided into thre (...truncated)


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Ma Dai-yuan, Tan Bang-xian, Li Xian-fu, Zhou Ye-qin, Cai Hong-Wei. A meta-analysis: neoadjuvant chemotherapy versus primary surgery in ovarian carcinoma FIGO stageIII and IV, World Journal of Surgical Oncology, 2013, pp. 267, 11, DOI: 10.1186/1477-7819-11-267