The Efficacy Of Neoadjuvant Chemotherapy Combined With Intermediate Cytoreductive Surgery For Advanced Ovarian Cancer To Achieve Grade R0:a Meta-analysis Of Randomized Controlled Studies

Objective:To systematically evaluate the efficacy and safety of neoadjuvant chemotherapy combined with interval debulking surgery(NACT-IDS)and primary debulking surgery(PDS)+ chemotherapy in the treatment of advanced ovarian cancer by Meta-analysis.Methods:Pub Med,Webof Science,Embase,and Cochrane databases were searched by computer to collect all prospective clinical trials comparing NACT-IDS and PDS in the treatment of advanced ovarian cancer from database establishment to November30,2020.The screening,data extraction,and risk of bias evaluation of literature were independently completed by two researchers according to the inclusion and exclusion criteria at the same time.Meta-analysis was performed using Rev Man 5.3software for pooled effect analysis of the finally included studies.Results:A total of 1383 articles were retrieved in this research,including 508 articles in Pub Med database,459 articles in Web of Science database,244 articles in Embase database,and 172 articles in The Cochrane Library database.After the elimination,1082 articles were obtained.Through preliminary reading titles and abstracts,1050 clinical experimental studies,retrospective studies,research on unrelated diseases,and literature with no survival outcomes were excluded,and 32 papers were included in the preliminary screening to further obtain the full text for reading screening.According to the inclusion and exclusion criteria,28 documents were read in full.Four randomized controlled studies with a total of 1692 patients were finally included in this study,of which 847 were treated with NACT-IDS and 845 with PDS.Meta-analysis showed that the ratio of the NACT-IDS group to obtain R0 curative effect was significantly increased than the PDS group(OR=2.92,95%CI: 1.98-4.30,P<0.0001).In terms of survival outcome,no further increase in overall survival was observed in the NACT-IDS group compared with the PDS group(HR = 0.95,95%CI: 0.86 – 1.06,P = 0.35),nor in progression-free survival(HR = 0.98,95% CI: 0.90– 1.08,P = 0.74).However,in terms of complications,the incidence of grade ≥ 3adverse events(AEs)was significantly reduced in the NACT-IDS group compared with the PDS group(OR = 0.25,95% CI: 0.15 – 0.41,P < 0.0001).Mortality was also significantly lower in the NACT-IDS group than in the PDS group(OR = 0.15,95% CI: 0.05-0.44,P < 0.001).Conclusion:The results of this Meta-analysis showed that NACT-IDS did not further improve the survival of patients with advanced ovarian cancer compared with the traditional PDS regimen.However,NACT-IDS significantly reduced the incidence of complications,especially grade 3 or higher AEs,and also significantly reduced the mortality rate.