Neoadjuvant chemotherapy for Patients with advanced epithelial ovarian cancer: A Meta-Analysis

The value of neoadjuvant chemotherapy (NAC) has not yet been fully defined. We aimed to systematically evaluate the influence of neoadjuvant chemotherapy (NAC) on survival and complete cytoreduction after debulking surgery in advanced epithelial ovarian cancer (AEOC) patients. We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for the randomized controlled trials (RCTs) comparing NAC and primary debulking surgery (PDS) in AEOC patients. The last search date is February 25, 2016. Cochrane systematic evaluation was used to evaluate bias risk of included studies. RevMan 5.3 software was used for statistical analysis. A total of 4 RCTs involving 1922 patients were included. Compared with PDS, NAC may contribute to the completeness of debulking removal [no residual disease (RR: 2.37; 95% CI: 1.94-2.91; P<0.00001), residual disease <= 1 cm (RR: 1.28; 95% CI: 1.04-1.57; P = 0.02), optimal cytoreduction rate (RR: 1.76; 95% CI: 1.57-1.98; P<0.00001)], but there were no significant differences in both groups with regard to overall survival (HR: 0.94; 95% Cl: 0.81-1.08; P = 0.38) and progression-free survival (HR: 0.89; 95% Cl: 0.77-1.03; P = 0.12). This meta-analysis indicates that the higher rate of optimal debulking made NAC more favorable as a treatment option for AEOC patients with non-inferior survival compared with PDS.