Prognostic factors for survival after neoadjuvant chemotherapy for advanced ovarian cancer: meta-analysis

Background: In advanced disease current practice is staging and primary debulking laparotomy followed by platinum-based chemotherapy. The effort to achieve ‘optimal debulking’ is associated with a complication risk of 8% 63% and a mortality rate of 1% 6%. Neoadjuvant chemotherapy has been proposed as an alternative option. Objectives: This meta-analysis aimed to determine prognostic factors influencing survival in patients with advanced ovarian cancer following neoadjuvant chemotherapy. Search Strategy: Clinical trials citing the terms ‘advanced ovarian cancer’, ‘ovarian cancer’, ‘neoadjuvant chemotherapy’ and ‘surgery’ were identified by searching Pubmed and ScienceDirect between January 1st 2000 and September 30th 2010. Data Collection and analysis: The trials included used platinum-based chemotherapy and involved stage III/IV disease that underwent neoadjuvant chemotherapy followed by surgery. Prognostic variables were identified for analysis including number/type of chemotherapy, % stage IV disease, % maximal cytoreductive surgery and whether a lymphadenectomy was performed. The % bowel surgery and ultra-radical surgery was also analysed. Main Results: Twenty six trials were identified as suitable for analysis and included 3 non-randomised Phase II studies, 2 retrospective case-control studies, 17 from retrospective analysis and 1 RCT. A significant association between taxane use vs platinum only (p = 0.019), year of publication (p = 0.032), % maximal interval cytoreduction (p = 0.046) and median overall survival was identified. No significant survival benefit was demonstrated with number of chemotherapy cycles (p = 0.065), lymphadenectomy (p = 0.813) and % bowel surgery performed (p = 0.606). Conclusions: The addition of taxane and % maximal cytoreduction achieved is associated with improved overall survival. There is, however no evidence that lymphadenectomy, number of chemotherapy cycles or bowel surgery influences survival.