Prognosis Following Surgery for Recurrent Ovarian Cancer and Diagnostic Criteria Predictive of Cytoreduction Success: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Strategy and Selection Criteria
2.2. Data Extraction, Quality Assessment and Analysis
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Secondary Cytoreduction Surgery | Tertiary Cytoreduction Surgery | Quaternary Cytoreduction Surgery |
---|---|---|
Platinum sensitive disease | Good performance status (ECOG 0) | ≤4 sites of disease |
Good performance status (ECOG 0–1) | Age < 60 years | |
No residual disease after primary cytoreduction surgery | Size of largest tumour ≤ 8 cm | |
FIGO stage I/II disease at diagnosis | Optimal primary (≤1 cm) and secondary (≤0.5 cm) cytoreduction surgery | |
Ascites < 500 mls | Time to first recurrence ≤ 32 months | |
Serum CA125 at recurrence ≤ 105 U/mL | Time from secondary cytoreduction ≤ 25 months | |
Progression free interval ≥ 16 months |
Variable | Estimate | SE | 95% CI | z | p | No. of Studies | I2, % | R2, % |
---|---|---|---|---|---|---|---|---|
Univariable analysis | ||||||||
Proportion of complete cytoreduction | −0.004 | 0.001 | −0.006 to −0.002 | −4.025 | <0.0001 | 33 | 80.7 | 38.5 |
Proportion of optimal cytoreduction | −0.005 | 0.002 | −0.008 to −0.002 | −3.425 | 0.0006 | 33 | 80.7 | 30.1 |
Median age | 0.012 | 0.009 | −0.004 to 0.029 | 1.442 | 0.149 | 30 | 85 | 1.6 |
DFI | −0.002 | 0.005 | −0.011 to 0.008 | −0.312 | 0.755 | 27 | 86.1 | 0 |
Pattern of relapse | 0.000 | 0.002 | −0.004 to 0.004 | 0.016 | 0.987 | 18 | 81.9 | 0 |
Post-operative morbidity | −0.003 | 0.002 | −0.008 to 0.001 | −1.357 | 0.175 | 29 | 85.4 | 2.7 |
Multivariable analysis | ||||||||
Proportion of complete cytoreduction | −0.006 | 0.001 | −0.008 to −0.004 | −5.322 | <0.0001 | 18 | 53.9 | 79 |
Median age | 0.019 | 0.008 | 0.003 to 0.036 | 2.254 | 0.024 | |||
DFI | 0.002 | 0.005 | −0.008 to 0.013 | 0.449 | 0.653 | |||
Post-operative morbidity | −0.003 | 0.002 | −0.008 to 0.001 | −1.385 | 0.166 | |||
Proportion of optimal cytoreduction | −0.007 | 0.002 | −0.01 to −0.003 | −3.739 | <0.0001 | 19 | 71.2 | 50.4 |
Median age | 0.014 | 0.011 | −0.007 to 0.035 | 1.291 | 0.035 | |||
DFI | 0.007 | 0.005 | −0.002 to 0.016 | 1.563 | 0.016 | |||
Post-operative morbidity | −0.002 | 0.003 | −0.008 to 0.004 | −0.721 | 0.471 |
Variable | Beta | SE | t-Value | p | Change in Median OS | |
---|---|---|---|---|---|---|
Increase Unit | % | |||||
Univariable analysis | ||||||
Proportion of complete cytoreduction | 0.009 | 0.003 | 3.433 | 0.002 | 10% | 9.83 |
Proportion of optimal cytoreduction | 0.008 | 0.004 | 1.953 | 0.062 | 10% | 8.61 |
Median age | 0.043 | 0.02 | 2.135 | 0.044 | 1 year | 4.38 |
Study design (prospective or retrospective) | 0.164 | 0.13 | 1.259 | 0.218 | Prospective | 17.81 |
DFI | 0.017 | 0.01 | 1.658 | 0.113 | 1 month | 1.71 |
Pattern of relapse | 0.006 | 0.007 | 0.904 | 0.383 | 10% | 6.6% |
Post-operative morbidity | −0.001 | 0.005 | −0.1 | 0.921 | 10% | −0.1 |
Multivariable analysis | ||||||
Proportion of complete cytoreduction | 0.007 | 0.002 | 2.884 | 0.015 | 10% | 7.43 |
DFI | 0.024 | 0.01 | 2.415 | 0.034 | 1 month | 2.46 |
Median age | 0.006 | 0.018 | 0.322 | 0.754 | 1 year | 0.6 |
Post-operative morbidity | −0.01 | 0.005 | −1.892 | 0.085 | 10% | −9.1 |
Proportion of optimal cytoreduction | 0.005 | 0.004 | 1.241 | 0.238 | 10% | 5.63 |
DFI | 0.009 | 0.013 | 0.708 | 0.492 | 1 month | 9.6 |
Median age | 0.028 | 0.025 | 1.129 | 0.281 | 1 year | 32.1 |
Post-operative morbidity | −0.008 | 0.008 | −1.058 | 0.311 | 10% | −7.85 |
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Gaba, F.; Blyuss, O.; Chandrasekaran, D.; Bizzarri, N.; Refky, B.; Barton, D.; Ind, T.; Nobbenhuis, M.; Butler, J.; Heath, O.; et al. Prognosis Following Surgery for Recurrent Ovarian Cancer and Diagnostic Criteria Predictive of Cytoreduction Success: A Systematic Review and Meta-Analysis. Diagnostics 2023, 13, 3484. https://doi.org/10.3390/diagnostics13223484
Gaba F, Blyuss O, Chandrasekaran D, Bizzarri N, Refky B, Barton D, Ind T, Nobbenhuis M, Butler J, Heath O, et al. Prognosis Following Surgery for Recurrent Ovarian Cancer and Diagnostic Criteria Predictive of Cytoreduction Success: A Systematic Review and Meta-Analysis. Diagnostics. 2023; 13(22):3484. https://doi.org/10.3390/diagnostics13223484
Chicago/Turabian StyleGaba, Faiza, Oleg Blyuss, Dhivya Chandrasekaran, Nicolò Bizzarri, Basel Refky, Desmond Barton, Thomas Ind, Marielle Nobbenhuis, John Butler, Owen Heath, and et al. 2023. "Prognosis Following Surgery for Recurrent Ovarian Cancer and Diagnostic Criteria Predictive of Cytoreduction Success: A Systematic Review and Meta-Analysis" Diagnostics 13, no. 22: 3484. https://doi.org/10.3390/diagnostics13223484