Prognosis Following Surgery for Recurrent Ovarian Cancer and Diagnostic Criteria Predictive of Cytoreduction Success: A Systematic Review and Meta-Analysis

For women achieving clinical remission after the completion of initial treatment for epithelial ovarian cancer, 80% with advanced-stage disease will develop recurrence. However, the standard treatment of women with recurrent platinum-sensitive diseases remains poorly defined. Secondary (SCS), tertia...

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Published in:Diagnostics (Basel) 2023-11, Vol.13 (22), p.3484
Main Authors: Gaba, Faiza, Blyuss, Oleg, Chandrasekaran, Dhivya, Bizzarri, Nicolò, Refky, Basel, Barton, Desmond, Ind, Thomas, Nobbenhuis, Marielle, Butler, John, Heath, Owen, Jeyarajah, Arjun, Brockbank, Elly, Lawrence, Alexandra, Manchanda, Ranjit, Dilley, James, Phadnis, Saurabh
Format: Article
Language:English
Subjects:
Cancer
Cancer therapies
Care and treatment
Chemotherapy
Cohort analysis
Development and progression
Diagnosis
diagnostics
Diseases
Drug resistance
Medical prognosis
Meta-analysis
Morbidity
Mortality
Observational studies
Ovarian cancer
prognosis
recurrence
Relapse
Surgery
Systematic review
Tumors
United Kingdom
Womens health
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Summary:For women achieving clinical remission after the completion of initial treatment for epithelial ovarian cancer, 80% with advanced-stage disease will develop recurrence. However, the standard treatment of women with recurrent platinum-sensitive diseases remains poorly defined. Secondary (SCS), tertiary (TCS) or quaternary (QCS) cytoreduction surgery for recurrence has been suggested to be associated with increased overall survival (OS). We searched five databases for studies reporting death rate, OS, cytoreduction rates, post-operative morbidity/mortality and diagnostic models predicting complete cytoreduction in a platinum-sensitive disease recurrence setting. Death rates calculated from raw data were pooled based on a random-effects model. Meta-regression/linear regression was performed to explore the role of complete or optimal cytoreduction as a moderator. Pooled death rates were 45%, 51%, 66% for SCS, TCS and QCS, respectively. Median OS for optimal cytoreduction ranged from 16–91, 24–99 and 39–135 months for SCS, TCS and QCS, respectively. Every 10% increase in complete cytoreduction rates at SCS corresponds to a 7% increase in median OS. Complete cytoreduction rates ranged from 9–100%, 35–90% and 33–100% for SCS, TCS and QCS, respectively. Major post-operative thirty-day morbidity was reported to range from 0–47%, 13–33% and 15–29% for SCS, TCS and QCS, respectively. Thirty-day post-operative mortality was 0–6%, 0–3% and 0–2% for SCS, TCS and QCS, respectively. There were two externally validated diagnostic models predicting complete cytoreduction at SCS, but none for TCS and QCS. In conclusion, our data confirm that maximal effort higher order cytoreductive surgery resulting in complete cytoreduction can improve survival.
ISSN:2075-4418
2075-4418
DOI:10.3390/diagnostics13223484