Objective To synthesize the role of secondary cytoreduction in recurrent ovarian cancer from the results of randomized studies.
Methods We conducted a meta-analysis of randomized controlled trials which compared secondary cytoreductive surgery versus no surgery in patients with platinum sensitive relapsed ovarian cancer. Individual patient data for overall survival and progression free survival were manually extracted from published survival curves, for whole study populations and subgroups based on completeness of surgical resection and bevacizumab use, using WebPlotDigitizer software. Overall survival and progression free survival curves for each study and the combined population were reconstructed from extracted data.
Results Three studies with 1249 patients were included, of whom complete resection was achieved in 427 (34.2%) patients. In individual patient data analysis of the whole study population with 562 deaths, there was no significant difference in overall survival between the surgery and no surgery groups (median 52.8 vs 52.1 months, respectively, hazard ratio (HR) 0.94, 95% confidence interval (CI) 0.80 to 1.11; p=0.5) but the surgery group had significantly longer progression free survival compared with the no surgery group (median 18.3 vs 14.4 months, respectively, HR 0.70, 95% CI 0.62 to 0.80; p<0.001). In subgroup analyses, overall survival was significantly longer in the complete cytoreduction subgroup compared with the no surgery group (median 62.0 vs 52.1 months, respectively, HR 0.70, 95% CI 0.57 to 0.92; p<0.001) while overall survival was significantly worse in the incomplete cytoreduction subgroup compared with the no surgery group (median 34.2 vs 52.1 months, respectively, HR 1.72, 95% CI 1.38 to 2.14; p<0.001). In the no bevacizumab subgroup, there was no significant overall survival difference between the surgery and no surgery groups (median 49.3 vs 47.0 months, HR 0.86, 95% CI 0.67 to 1.10; p=0.25).
Conclusions Secondary cytoreductive surgery among women with platinum-sensitive relapsed ovarian cancer did not lead to significant benefit in overall survival although it increased progression free survival. However, overall survival was significantly longer among patients in whom complete cytoreduction was possible compared with no surgery.
- ovarian neoplasms
- cytoreduction surgical procedures
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
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SG and SK contributed equally.
Presented at The content of this manuscript has been presented in part at ESMO Asia Congress (December 2-4, 2022, Singapore, selected as mini oral presentation in gynecological cancers session).
Contributors Conception and design: SGup, SGul, and SK. Collection and assembly of data: SGul, SK, SGup, SR, JG, and AM. Data analysis and interpretation: SK, SGul, and SGup. Manuscript writing, final approval of the manuscript, and accountable for all aspects of the work: all authors. Access to data and data analysis: SGup, the principal investigator, had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. SGup is the guarantor of this study and accepts full responsibility for the work and the conduct of the study, had access to the data, and controlled the decision to publish.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.
Competing interests SGul: institutional financial interest for conducted research from Eli Lilly, Pfizer, Celltrion, Kendle India, and Zydus; non-remunerated activities include advisory board of Novartis and Eisai. SR: institutional financial interest for conducted research from AstraZeneca and JSS Clinical Research. SGup: institutional financial interest for conducted research from Roche, Sanofi, Johnson & Johnson, Amgen, Celltrion, Oncosten, Novartis, Intas, Eisai, Biocon, and AstraZeneca; non-remunerated activities include advisory board of Sanofi, Dr Reddy’s Laboratories, Biocon, Pfizer, Oncosten, Core Diagnostics, and AstraZeneca; general secretary of non-profit organization, Women Cancer Initiative and president-elect of the Indian Society of Medical and Pediatric Oncology.
Provenance and peer review Not commissioned; externally peer reviewed.
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