Secondary cytoreductive surgery in platinum-sensitive relapsed ovarian cancer: a meta-analysis of randomized controlled trials

Purpose To evaluate the role of secondary cytoreduction in patients with platinum-sensitive recurrent ovarian cancer. Methods The PubMed, Medline, Embase, Cochrane Library and Web of Science databases were searched. Randomized controlled trials (RCTs) that compare secondary cytoreduction plus chemotherapy with chemotherapy alone in patients with platinum-sensitive relapsed ovarian cancer were selected. Pooled hazard ratios (HR) with 95% confidence intervals (CIs) were calculated. Results There was no difference in overall survival (OS) between the surgery group and no surgery group (HR = 0.89; 95% CI 0.77, 1.04; p = 0.14), but secondary cytoreduction showed a significant improvement in progression-free survival (PFS) (HR = 0.67; 95% CI 0.54, 0.76; p < 0.00001). A subgroup analysis comparing the complete gross resection subpopulation with the no surgery group achieved a significant longer OS (HR = 0.70, 95% CI 0.58-0.85; p = 0.0003) and a greater PFS benefit (HR = 0.56, 95% CI 0.48-0.66; p < 0.00001). In addition, as compared with incomplete resection, the OS benefit of complete gross resection was more evident (HR = 0.51, 95% CI 0.37-0.69; p < 0.0001). Conclusions In women with platinum-sensitive recurrent ovarian cancer, although secondary cytoreduction followed by chemotherapy resulted in longer PFS than chemotherapy alone, it did not lead to significant benefit in OS. However, when complete gross resection was achieved, it significantly prolonged OS and provided a greater PFS benefit.