The Role Of Neoadjuvant Chemotherapy Followed By Interval Debulking Surgery In Advanced Ovarian Cancer:A Systematic Review And Meta-analysis

Objective:We aimed to performed a meta-analysis and systematic review on the role of neoadjuvant chemotherapy followed by interval debulking surgery in advanced ovarian cancer patients.Methods:We searched PubMed,EMBASE,and the Cochrane Library for relevant articles.All statistical analyses were performed in Review Manager 5.3.5.Results:In two RCTs,few adverse events(HR=0.37,95%Cl:0.19-0.72)and a high optimal debulking surgery rate(HR=1.69,95%Cl:1.50-1.91)were observed with NACT.There was no significant difference in PFS(HR=0.97,95%Cl:0.86-1.09)or OS(HR=0.93,95%Cl:0.81-1.06).In 22 observational studies,an increased optimal cytoreduction rate(HR=1.17,95%Cl:1.12-1.22)was observed with NACT.Primary debulking surgery yielded better OS(HR=1.38,95%Cl:1.19-1.60)but not PFS(HR=1.03,95%Cl:0.86-1.23).A further subgroup analysis showed that the OS of patients with the same surgical outcome(R0:HR=2.66,95%Cl:1.72 to 4.11;R1:HR=1.61,95%CI:1.11 to 2.35;R2:HR=1.54,95%Cl:1.04 to 2.27)and the same clinical FIGO stage(FIGO III stage:HR=1.43,95%Cl:1.05-1.95;FIGO IV stage:HR=1.14,95%Cl:1.06-1.23)in PDS group was significantly higher than NACT group.Conclusion:Treatment with NACT-IDS improves perioperative outcomes and optimal cytoreduction rates,but it may not improve OS.NACT-IDS is not inferior to PDS-CT in terms of survival outcomes in selected AOC patients.Future evidence-based studies should focus on candidate selection for NACT.