The prognosis impact of NACT-IDS and PDS in advanced ovarian cancer: a systematic review and meta-analysis

Objective: We aimed to explore the prognostic implications of neoadjuvant chemotherapy and interval debulking surgery (NACT-IDS) compared to primary debulking surgery (PDS) in patients diagnosed with advanced ovarian cancer by meta-analysis. Methods: The search was conducted across PubMed, Web of Science, Cochrane, Wanfang Data, China National Knowledge Infrastructure, and the Chinese BioMedical Literature Database to identify pertinent studies examining the prognostic implications of NACT-IDS versus PDS in patients with advanced ovarian cancer. Results: As of September 11, 2023, a total of 29 articles were ultimately included, encompassing 12,916 patients with advanced ovarian cancer in this meta-analysis. NACT-IDS groups exhibited a higher satisfactory tumor reduction rate (odds ratio [OR]=2.06; 95% confidence interval [CI]=1.53 to 2.76; p<0.001). NACT-IDS effectively reduced the risk of adverse cardiac events (OR=0.36; 95% CI=0.17 to 0.80; p=0.012), surgical site infections (OR=0.42; 95% CI=0.29 to 0.60; p<0.001), and embolic complications (OR=0.43; 95% CI=0.24 to 0.75; p=0.003) in patients with advanced ovarian cancer. Compared to NACT-IDS therapy for International Federation of Gynecology and Obstetrics (FIGO) III-IV ovarian cancer patients (OR=1.66; 95% CI=1.24 to 2.23; p=0.009), NACT-IDS groups exhibited a higher satisfactory tumor reduction rate for FIGO IIIC-IV (OR=2.35; 95% CI=1.50 to 3.70; p<0.001). Conclusion: NACT-IDS effectively enhances the satisfactory tumor reduction rate, especially for patients with stage IIIC and IV, and decreases postoperative complications among patients with advanced ovarian cancer.