Prognosis Following Surgery for Recurrent Ovarian Cancer and Diagnostic Criteria Predictive of Cytoreduction Success: A Systematic Review and Meta-Analysis
Faiza Gaba,
Oleg Blyuss,
Dhivya Chandrasekaran,
Nicolò Bizzarri,
Basel Refky,
Desmond Barton,
Thomas Ind,
Marielle Nobbenhuis,
John Butler,
Owen Heath,
Arjun Jeyarajah,
Elly Brockbank,
Alexandra Lawrence,
Ranjit Manchanda,
James Dilley,
Saurabh Phadnis,
on behalf of the GO SOAR Collaborative
Affiliations
Faiza Gaba
Department of Gynaecological Oncology, The Royal Marsden Hospital, London SW3 6JJ, UK
Oleg Blyuss
Wolfson Institute of Preventive Medicine, Barts CRUK Cancer Centre, Queen Mary University of London, London EC1M 6BQ, UK
Dhivya Chandrasekaran
Department of Gynaecological Oncology, University College London Hospital, London NW1 2BU, UK
Nicolò Bizzarri
Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
Basel Refky
Department of Surgical Oncology, Mansoura University, El Mansoura 7650030, Egypt
Desmond Barton
Department of Gynaecological Oncology, The Royal Marsden Hospital, London SW3 6JJ, UK
Thomas Ind
Department of Gynaecological Oncology, The Royal Marsden Hospital, London SW3 6JJ, UK
Marielle Nobbenhuis
Department of Gynaecological Oncology, The Royal Marsden Hospital, London SW3 6JJ, UK
John Butler
Department of Gynaecological Oncology, The Royal Marsden Hospital, London SW3 6JJ, UK
Owen Heath
Department of Gynaecological Oncology, The Royal Marsden Hospital, London SW3 6JJ, UK
Arjun Jeyarajah
Department of Gynaecological Oncology, The Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK
Elly Brockbank
Department of Gynaecological Oncology, The Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK
Alexandra Lawrence
Department of Gynaecological Oncology, The Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK
Ranjit Manchanda
Wolfson Institute of Preventive Medicine, Barts CRUK Cancer Centre, Queen Mary University of London, London EC1M 6BQ, UK
James Dilley
Department of Gynaecological Oncology, The Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK
Saurabh Phadnis
Department of Gynaecological Oncology, The Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UK
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.
