Does neoadjuvant chemotherapy increase optimal cytoreduction rate in advanced ovarian cancer? Meta-analysis of 21 studies.

Abstract

The purpose of the current study is to analyze the existing data regarding neoadjuvant chemotherapy (NAC) in advanced epithelial ovarian cancer (EOC) using a random-effects model and to determine whether NAC can improve the rate of optimal cytoreduction. Between 1989 and 2008, data of 21 studies were retrieved via a MEDLINE search. Meta-regression analysis based on a random-effects model was performed to assess the prognostic value of clinical variables. The patients who received NAC had a lower risk of suboptimal cytoreduction than the patients with favorable conditions (pooled odds ratio, 0.50; 95% confidence interval, 0.29-0.86; P = 0.012 with DerSimonian-Laird model). Meta-regression analysis revealed that heterogeneity in year of publication, taxane use, and optimal cytoreduction rate influenced median overall survival significantly (P = 0.002, P = 0.007, and P = 0.012, respectively). However, the between-studies variation of the number of NAC cycles did not influence survival (P = 0.701). The current meta-analysis showed that NAC helped the gynecologic oncologist achieve an increased rate of optimal cytoreduction.