A Systematic Review Of The Secondary Cytoreductive Surgery In Platinum-sensitive Ecurrent Ovarian Cancer

Objects:Ovarian cancer(OC)is one of the most common female tumor types,which could achieve a clinical remission rate of 80% ~ 90%,however,there is around 60%~ 70% recurrence rate and no standard treatment for recurrent ovarian cancer(ROC).For platinum-sensitive recurrent patients,previous studies showed that the secondary cytoreductive surgery(SCR)could prolong the overall survival,however,there are only ongonging randomized controlled trials.In this paper,we performed a systematic review by collecting the published studies of SCR in patients with ROC to address two issues in OC treatment: study the survival difference between SCR and chemotherapy alone in platinum-sensitive ROC;study if SCR with no residual tumor can prolong overall survival of platinum-sensitive ROC comparing with any size of residual tumor.Methods:A comprehensive search was performed through multiple databases including:The Cochrane Library,Pub Med,Embase,Chinese Biomedical Literature Database(CBM),Chinese National Knowledge Infrastructure(CNKI),Wanfang Database,searching from inception to October,2016.Two reviewers independently screened literature,extracted data,and assessed the risk of bias of included studies.Then meta analysis was performed using Rev Man 5.3.Results:A total of 21 studies involving 5375 patients were included.The average age was55.14 years,average follow-up was 36.96 months,average median PFS before relapse was 20.95 months,after relapse,average median survival was 35.01 months,median PFS was 18 months.The average hospital stay was 11 days(2-97 days),the operation time was 247 minutes(26-600 minutes),the intraoperative blood loss was 524ml(50-6000ml),the average rate of residual surgery was 57.72%(38%-82.1%),the complete surgery rate of optimal SCR was 70.35%(38.3%-89.36%),the average surgical morbidity was4.1%to43.3%,the average mortality was 1.12%.Our meta analysis indicated that: Compared with chemotherapy alone,SCR followed by chemotherapy can prolong the overall survival of platinum-sensitive ROC(HR=1.34,95%CI(1.22-1.46),P<0.00001).For overall survival,Hazard ratio(HR)is 3.10 between RD>0cm and RD=0cm,with 95% confidence interval(CI)2.25 to 4.27,P<0.0001;HR is 2.86 between RD≤0.5cm and RD=0cm,with 95% CI 1.28 to 5.90,P=0.0.005;HR is 2.91 between RD≤1cm and RD=0cm,with 95% CI 2.36 to 3.59,P<0.00001;HR is 5.86 between RD≥1cm and RD=0cm,with 95% CI 4.42 to 7.77,P< 0.0001;HR is 2.56 between RD≥2cm and RD=0cm,with 95% CI 1.45 to4.52,P=0.001,and the subgroup analysis revealed that the overall survival of SCR with no residual tumor prolonged significantly(HR is 3.37,95% CI 2.84 to 3.99,P<0.00001)comparing with SCR without any size of residual tumor.There are only two studies compared the quality of life of patients treated with chemotherapy alone and chemotherapy after SCR,all suggested that the effect of surgery on the quality of life of ROC is negligible.Conclusions:1.SCR showed a good curative effect on prolonging the overall survival of platinum-sensitive recurrent OC,but there is no standard prediction or risk model currently,so the treatment should be comprehensive evaluated and rationally individualized choice.2.There was a significant prolonged overall survival comparing no residual tumor with any size of residual tumor after SCR,therefore SCR should try to leave no residual tumor,at least reduce the size under 1 cm.3.There are several on-going randomized controlled trials about SCR in ROC,all are performed to evaluate the efficacy,safety,and quality of life comparing SCR with chemotherapy alone,which should provide more evidence on the curative effect of SCR in recurrent OC.