TY - JOUR
T1 - The Role of Secondary Cytoreductive Surgery in Recurrent Ovarian Cancer: A Systematic Review and Meta-Analysis
AU - Marchetti, Claudia
AU - Fagotti, Anna
AU - Tombolini, Vincenzo
AU - Scambia, Giovanni
AU - De Felice, Francesca
PY - 2020
Y1 - 2020
N2 - Background: Phase 3 randomized clinical trials have been designed to compare secondary cytoreductive surgery followed by systemic therapy with systemic therapy alone for management of patients with recurrent ovarian cancer. This study aimed to compare differences in clinical outcomes between these two treatment approaches. Methods: The PRISMA statement was applied. Only phase 3 randomized clinical trials were included in the final analysis. Results: Three randomized clinical trials (n = 1250 patients) were identified. Secondary cytoreductive surgery was associated with significantly better progression-free survival (PFS) improvement than systemic therapy alone (hazard ratio [HR], 95% CI, 0.61–0.78; p < 0.001). The PFS benefit was greater for the complete resection subpopulation (HR, 0.56; 95% CI, 0.48–0.66; p < 0.001). The HR of overall survival (OS) was similar between the groups (HR, 0.93; 95% CI, 0.78–1.10; p = 0.37), but it was 0.73 (95% CI, 0.59–0.91) in favor of the complete resection subpopulation. Conclusion: This meta-analysis showed secondary cytoreductive surgery as superior to systemic therapy alone in terms of PFS. The PFS and OS benefits were particularly observed for complete surgical resection. The impact on OS in the general population remains to be proven.
AB - Background: Phase 3 randomized clinical trials have been designed to compare secondary cytoreductive surgery followed by systemic therapy with systemic therapy alone for management of patients with recurrent ovarian cancer. This study aimed to compare differences in clinical outcomes between these two treatment approaches. Methods: The PRISMA statement was applied. Only phase 3 randomized clinical trials were included in the final analysis. Results: Three randomized clinical trials (n = 1250 patients) were identified. Secondary cytoreductive surgery was associated with significantly better progression-free survival (PFS) improvement than systemic therapy alone (hazard ratio [HR], 95% CI, 0.61–0.78; p < 0.001). The PFS benefit was greater for the complete resection subpopulation (HR, 0.56; 95% CI, 0.48–0.66; p < 0.001). The HR of overall survival (OS) was similar between the groups (HR, 0.93; 95% CI, 0.78–1.10; p = 0.37), but it was 0.73 (95% CI, 0.59–0.91) in favor of the complete resection subpopulation. Conclusion: This meta-analysis showed secondary cytoreductive surgery as superior to systemic therapy alone in terms of PFS. The PFS and OS benefits were particularly observed for complete surgical resection. The impact on OS in the general population remains to be proven.
KW - Cytoreductive Surgery
KW - Ovarian Cancer
KW - Cytoreductive Surgery
KW - Ovarian Cancer
UR - http://hdl.handle.net/10807/167513
U2 - 10.1245/s10434-020-09226-7
DO - 10.1245/s10434-020-09226-7
M3 - Article
SN - 1068-9265
SP - N/A-N/A
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
ER -