Survival outcome and perioperative complication related to neoadjuvant chemotherapy with carboplatin and paclitaxel for advanced ovarian cancer: A systematic review and meta-analysis

Hiroko Machida, Hideki Tokunaga, Koji Matsuo, Noriomi Matsumura, Yoichi Kobayashi, Tsutomu Tabata, Masanori Kaneuchi, Satoru Nagase, Mikio Mikami

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)

Abstract

Objective: To compare the effectiveness and safety of neoadjuvant chemotherapy with carboplatin/paclitaxel followed by interval debulking surgery (NACT-IDS) to primary debulking surgery plus postoperative chemotherapy (PDS) for advanced ovarian cancer. Methods: A comprehensive systematic review and meta-analysis were conducted by an Expert Panel of the Japan Society of Gynecologic Oncology Ovarian Cancer Committee. Multiple public search engines including PubMed/MEDLINE and the Cochrane Database, were searched in March 2019 using the entry keywords “ovarian cancer [all fields]" AND “interval debulking surgery [all fields]”, AND “neoadjuvant chemotherapy [all fields]”. Key inclusion criteria were prospective clinical trials examining platinum-based NACT for stage II-IV epithelial ovarian cancer. The primary outcome of interest was survival, and the secondary outcome was adverse events with each intervention. Results: After screening 333 studies, four phase III randomized clinical trials were identified that met the inclusion criteria. These trials included 1692 women (847 receiving NACT-IDS and 845 receiving PDS). It was found that NACT-IDS and PDS had similar overall survival (hazard ratio [HR]: 0.97, 95% confidence interval [CI]: 0.87–1.07, P = 0.53) and progression-free survival (HR: 0.98, 95%CI: 0.90–1.08, P = 0.74). In contrast, NACT-IDS was associated with significantly lower rates of perioperative complications (odds ratio [OR] 0.27, 95%CI: 0.20–0.36, P < 0.001) and perioperative mortality (OR: 0.17, 95%CI: 0.06–0.50, P < 0.001) compared to PDS. Conclusion: This systematic review and meta-analysis suggests that NACT-IDS with carboplatin and paclitaxel does not negatively impact the survival of women with advanced ovarian cancer compared to PDS, while perioperative complications and mortality are significantly reduced by 70–80%.

Original languageEnglish
Pages (from-to)868-875
Number of pages8
JournalEuropean Journal of Surgical Oncology
Volume46
Issue number5
DOIs
Publication statusPublished - 2020 May

Keywords

  • Meta-analysis
  • Neoadjuvant chemotherapy
  • Ovarian cancer
  • Perioperative complication
  • Survival
  • Systematic review

ASJC Scopus subject areas

  • Surgery
  • Oncology

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