D. Chase, A. Mahajan, D.A. Scott, N. Hawkins, T. Woodward, L. Kalilani
This systematic literature review and meta-analysis evaluated the impact of residual disease (RD) status on overall survival (OS) and progression-free survival (PFS) in adults aged ≥18 years with ovarian cancer who had undergone primary debulking or interval debulking surgery.
MEDLINE, Embase and Cochrane Central were searched between 1 January 2011 and 7 July 2020 to identify eligible clinical trials or observational studies conducted in the target population. Gray literature, bibliographies and conference proceedings were also searched. The objectives were to ascertain the OS and PFS, and use meta-analysis to determine the impact of RD status on these outcomes, with RD status defined as no RD (0 cm), optimal cytoreduction (RD ≤1 cm) or suboptimal cytoreduction (RD >1 cm).
Forty-seven observational studies and three randomized controlled trials were eligible for inclusion, with sample sizes ranging between 203 and 8,652 patients. Median OS and median PFS were 49.9 months and 25.6 months, respectively, among patients with RD 0 cm, and meta-analysis showed that increasing RD status was associated with statistically significant (p<0.05) increases in both mortality and progression. Hazard ratios (HRs) of OS ranged upwards of 1.75 for RD ≤1 vs 0 cm (95% confidence interval [CI] 1.62–1.90) and increased greater than 2-fold for RD >1 vs 0 cm (2.32; 95% CI 1.97–2.72) and >2 vs 0 cm (2.37; 95% CI 2.08–2.70), with an overall comparison of any RD vs no RD yielding a HR of 1.99 (95% CI 1.86–2.12). HRs of PFS ranged upwards of 1.75 for RD ≤1 vs 0 cm (95% CI 1.42–2.16) and increased greater than 2-fold for RD >1 vs 0 cm (2.14; 95% CI 1.34–3.39), with an overall comparison of any RD vs no RD yielding a HR of 1.88 (95% CI 1.62–2.18).
The results of this meta-analysis affirm prior studies and further quantify the impact of RD status following primary debulking or interval debulking surgery in first-line ovarian cancer. RD was highly predictive of OS and PFS, with improved OS and PFS associated with lower RD status. RD is one of the key factors impacting disease progression. RD status could be included in categories such as low- versus high-risk disease and may be associated with tumor biology or other patient-related factors.
