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Does Time-to-Chemotherapy Impact the Outcomes of Resected Ovarian Cancer? Meta-analysis of Randomized and Observational Data
  1. Pedro Luiz Serrano Usón, MD,
  2. Diogo Diniz Gomes Bugano, MD,
  3. Monique Sedlmaier França, MD,
  4. Yuri Philippe Pimentel Vieira Antunes, MD,
  5. Patricia Taranto, MD,
  6. Rafael Aliosha Kaliks, MD and
  7. Auro Del Giglio, MD, PhD
  1. Oncology Department, Hospital Israelita Albert Einstein, São Paulo, Brazil.
  1. Address correspondence and reprint requests to Pedro Luiz Serrano Usón Junior, MD, Oncology Department, Hospital Israelita Albert Einstein, 627/701 Av. Albert Einstein, São Paulo, CEP 05651-901, Brazil. E-mail: pedroluiz_uson{at}


Objectives This study is a meta-analysis of prior publications evaluating the impact of time-to-chemotherapy (TTC) on disease recurrence and survival 3 years after the original surgery.

Methods We performed a meta-analysis of studies published in PubMed (1950–2016) as of April 2016. Inclusion criteria were as follows: randomized controlled trials and prospective or retrospective cohorts that included patients with ovarian cancer who had undergone surgery with curative intent and use of adjuvant chemotherapy. We compared rates of disease recurrence and death according to the TTC (“early” vs “delayed”) using a random-effects model and performed a metaregression to evaluate the impact of covariates on these outcomes.

Results Of 239 abstracts in the original search, 12 were considered eligible. The cutoffs used for TTC were between 20 and 40 days. All studies used a platinum-based chemotherapy, and the rates of patients with suboptimal resection varied from 33% to 70%. A longer TTC was not associated with higher rates of disease recurrence (odds ratio, 0.89; 95% confidence interval, 0.63–1.24) or death at 3 years (odds ratio, 1.06; 95% confidence interval, 0.9–1.24). There was no evidence of significant publication bias (Egger test P = 0.472), but data were heterogeneous (I2 = 64.3%). Metaregression showed that the percentage of patients with suboptimal surgery and values used as cutoff to define “delayed” chemotherapy combined were a significant source of bias (residual I2 = 0%).

Conclusions In our analysis, TTC after surgery for ovarian cancer with curative intent was not associated with higher risk of disease recurrence or death. However, this association was influenced by the rate of optimal debulking and definition of “late” initiation of chemotherapy, so we must be careful when applying these data to patients with complete resection.

  • Adjuvant chemotherapy
  • Ovarian carcinoma
  • Time to chemotherapy

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  • The authors declare no conflicts of interest.