Platinum-Based Neoadjuvant Chemotherapy versus Primary Surgery in Ovarian Carcinoma International Federation of Gynecology and Obstetrics Stages IIIc and IV: A Systematic Review and Meta-Analysis

Yunyun, Xiao; Xie, Shuang; Wang, Jiao; Lv, Chao; Guo, Jiao; Yang, Qing

doi:10.1159/000485618

Cited by 13 publications

(7 citation statements)

References 35 publications

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“…We found a survival benefit of upfront surgery over NACT, with an additional 33 months of OS in patients undergoing PDS compared with patients undergoing early IDS or DDS. Our findings are concordant with several previous reports showing that upfront cytoreduction offers a survival benefit over IDS [ 4 5 29 30 ]. Hypothetically, delaying CRS after NACT promotes the selection of chemoresistant tumor cells, as the probability of developing chemoresistance increases with the increasing number of tumor cells.…”

Section: Discussionsupporting

confidence: 93%

Effect of tumor burden and radical surgery on survival difference between upfront, early interval or delayed cytoreductive surgery in ovarian cancer

et al. 2021

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Objective We sought to evaluate the impact on survival of tumor burden and surgical complexity in relation to the number of cycles of neoadjuvant chemotherapy (NACT) in patients with advanced ovarian cancer (OC) with minimal (CC-1) or no residual disease (CC-0). Methods This retrospective study included patients with International Federation of Gynaecology and Obstetrics IIIC–IV stage OC who underwent debulking surgery at 4 high-volume institutions between January 2008 and December 2015. We assessed the overall survival (OS) of primary debulking surgery (PDS group), early interval debulking surgery after 3–4 cycles of NACT (early IDS group) and delayed debulking surgery after 6 cycles (DDS group) with CC-0 or CC-1 according to peritoneal cancer index (PCI) and Aletti score. Results Five hundred forty-nine women were included: 175 (31.9%) had PDS, 224 (40.8%) early IDS and 150 (27.3%) DDS. Regardless of Aletti score, median OS after PDS was significantly higher than after early IDS or DDS, but the survival difference was higher in women with an Aletti score <8. Among patients with PCI ≤10, median OS after PDS was significantly higher than after early IDS or DDS. In women with PCI >10, there were no differences between PDS and early IDS, but DDS was associated with decreased OS. Conclusion The benefit of complete PDS compared with NACT was maximal in patients with a low complexity score. In patients with low tumor burden, there was a survival benefit of PDS over early IDS or DDS. In women with high tumor load, DDS impaired the oncological outcome.

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Section: Discussionsupporting

confidence: 93%

Effect of tumor burden and radical surgery on survival difference between upfront, early interval or delayed cytoreductive surgery in ovarian cancer

et al. 2021

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“…Optimal cytoreduction is a critical prognostic factor for prolonged survival, whether it is performed before or after chemotherapy. Recent studies have suggested that NACT have reduced morbidity after surgery and are more suitable for optimal debulking surgery [9, 11–13, 27, 28]. NACT followed by IDS (NACT-IDS) is considered to be an alternative to conventional PDS for treating advanced ovarian cancer patients and expected to have better prognosis.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the benefits of neoadjuvant chemotherapy for advanced epithelial ovarian cancer: a retrospective study

Gao

Zhang

et al. 2019

J Ovarian Res

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Objective To compare the chemoresistance and survival in patients with stage IIIC or IV epithelial ovarian cancer who were treated with neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) or primary debulking surgery (PDS). The clinical characteristics of patients who benefited from NACT were further evaluated. Methods We retrospectively analyzed 220 patients who underwent NACT followed by IDS or PDS from January 2002 to December 2016. Differences in clinicopathological features, chemoresistance and prognosis were analyzed. Results The incidence rate for optimal cytoreduction and chemoresistance in the NACT group was relatively higher than PDS group. No differences were observed in progression free survival or overall survival. Patients without macroscopic RD in NACT group (NACT-R0) had a similar prognosis compared to those in PDS group who had RD<1 cm, and a relatively better prognosis compared to the PDS group that had RD ≥ 1 cm. The survival curve showed that patients in NACT-R0 group that were chemosensitive seemed to have a better prognosis compared to patients in PDS group that had RD. Conclusion Patients without RD after PDS had the best prognosis, whereas patients with RD after NACT followed by IDS had the worst. However, even if patients achieved no RD, their prognosis varied depending on chemosensitivity. Survival was better in patients who were chemosensitive compared to thosewho underwent PDS but had RD. Hence evaluating the chemosensitivity and feasibility of complete cytoreduction in advance is crucial.

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“…Globally, there were approximately 230 000 new cases in 2012 and the death toll was 150 000 [ 21 ]. Primary cytoreductive surgery and platinum-based adjuvant chemotherapy are still the criterion standard treatment for EOC patients [ 22 ]. However, most of these patients were diagnosed in the advanced stage, and half of the patients relapsed within 16 months, with a 5-year overall survival rate of less than 50% [ 23 – 26 ].…”

Section: Resultsmentioning

confidence: 99%

Prognostic Significance of CA125 Dynamic Change for Progression Free Survival in Patients with Epithelial Ovarian Carcinoma

Yin

Ren

et al. 2020

Med Sci Monit

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Background This study aimed to investigate the value of CA125 dynamic change in PFS prediction for patients with epithelial ovarian carcinoma (EOC). Material/Methods Data analysis was performed using SPSS 24.0 statistical software with progression-free survival (PFS) as an outcome measure. Kaplan-Meier method was used to analyze the relationship between PFS and preoperative and postoperative NLR, PLR and CA125 levels, CA125 half-life, CA125-negative time, age, FIGO stage, histopathology, differentiation, vessel carcinoma embolus, and ascites. The survival curves were compared by the log-rank test. Based on the results of single-factor analysis, the Cox model was used for multifactor analysis to analyze independent risk factors affecting the PFS of epithelial ovarian carcinoma. Results A total of 117 patients with EOC were selected from January 2012 to January 2019 to carry out a retrospective study. Univariate analyses showed that PFS of the patients with EOC was associated with differentiation, vessel carcinoma embolus, FIGO stage, CA125 half-life, CA12-negative time, and preoperative NLR (P<0.05). Multivariate analysis by the Cox model showed that vessel carcinoma embolus, CA125 half-life, differentiation, and preoperative NLR are the independent risk factors for PFS in patients with EOC. Conclusions The serum CA125 dynamic as reflected by CA125 half-life is the most important independent prognostic factor in patients with EOC. The simplicity of CA125 monitoring and its correlation with EOC patient survival can identify patients with poor prognosis through monitoring CA125 half-life, which can provide a reference value for use in clinical practice.

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Platinum-Based Neoadjuvant Chemotherapy versus Primary Surgery in Ovarian Carcinoma International Federation of Gynecology and Obstetrics Stages IIIc and IV: A Systematic Review and Meta-Analysis

Cited by 13 publications

References 35 publications

Effect of tumor burden and radical surgery on survival difference between upfront, early interval or delayed cytoreductive surgery in ovarian cancer

Effect of tumor burden and radical surgery on survival difference between upfront, early interval or delayed cytoreductive surgery in ovarian cancer

Evaluating the benefits of neoadjuvant chemotherapy for advanced epithelial ovarian cancer: a retrospective study

Prognostic Significance of CA125 Dynamic Change for Progression Free Survival in Patients with Epithelial Ovarian Carcinoma

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