A Meta-Analysis on the Impact of Platinum-Based Adjuvant Treatment on the Outcome of Borderline Ovarian Tumors With Invasive Implants

Abstract

Background. Treatment of borderline ovarian tumors (BOTs) remains contentious, and there is no consensus regarding therapy for BOTs with invasive implants (BOTi). The benefits of platinum‐based adjuvant treatment were evaluated in patients with BOTi at primary diagnosis. Methods. The PubMed database was systematically searched for articles using the following terms: ((borderline) OR (low malignant potential) AND (ovarian)) AND ((tumor) OR (cancer)) AND (invasive implants) AND ((follow‐up) OR (survival) OR (treatment) OR (chemotherapy) OR (adjuvant treatment) OR (surgery) OR (surgical treatment)). Results. We identified 27 articles including 3,124 patients, 181 with invasive implants. All studies provided information regarding mortality or recurrence rates. Central pathological examination was performed in 19 studies. Eight studies included more than 75% stage I patients; 7 included only advanced‐stage patients, and 14 included only serous BOT. The pooled recurrence estimates for both treatment groups (adjuvant treatment: 44.0%, upfront surgery: 21.3%) did not differ significantly (p = .114). A meta‐analysis of the 6 studies providing separate mortality data for both treatment groups favored surgical treatment only, but this difference did not reach statistical significance (.05 < p < .1; odds ratio: 0.33; 95% confidence interval: 0.09–1.71; p = .086). We were unable to pool the results of the included studies because not all studies registered events in both treatment groups. Egger's regression indicated low asymmetry of the studies (p = .39), and no heterogeneity was found (I2 = 0%). Conclusion. We did not find evidence supporting platinum‐based adjuvant therapy for BOT with invasive implants.

Identification of factors that impact recurrence in patients with borderline ovarian tumors

“…Other studies report no benefits of adjuvant chemotherapy regardless of stage or tumor histology [34, 35]. A meta-analysis revealed no significant effect of adjuvant chemotherapy on survival in BOT patients with invasive implants [36]. Findings reported here are in agreement with these reports: our multivariate model showed adjuvant chemotherapy is not a factor that is significantly associated with PFS.…”

ESMO–ESGO consensus conference recommendations on ovarian cancer: pathology and molecular biology, early and advanced stages, borderline tumours and recurrent disease

“…According to the available evidence, there is no benefit in adding adjuvant treatment to upfront surgery in patients with sBOTs with invasive implants 111 151–171. A meta-analysis on BOTs concluded that there is no evidence supporting the use of any specific type of adjuvant treatment 153. However, considering the low risk of invasive high-grade relapse, it is unlikely that it will be possible to demonstrate the efficacy of adjuvant treatment in these patients.…”

Conservative surgery in ovarian borderline tumours: A meta-analysis with emphasis on recurrence risk

“…The basic treatment for BOT is surgery, while indications for adjuvant treatment seem to be limited with neither randomised studies nor literature reviews having demonstrated the advantage of adjuvant therapy on survival [29,30]. The surgical treatment for BOT is historically based on the treatment of IOC, where the performance of a hysterectomy is justified to diagnose microscopic peritoneal implants on the surface of the uterine serosa.…”