Secondary cytoreductive surgery for recurrent low-grade serous ovarian carcinoma: A systematic review and meta-analysis

Rebecca M Goldberg; Soyoun Rachel Kim; Rouhi Fazelzad; Xuan Li; Theodore J Brown; Taymaa May

doi:10.1016/j.ygyno.2021.10.080

Secondary cytoreductive surgery for recurrent low-grade serous ovarian carcinoma: A systematic review and meta-analysis

Gynecol Oncol. 2022 Jan;164(1):212-220. doi: 10.1016/j.ygyno.2021.10.080. Epub 2021 Oct 28.

Authors

Rebecca M Goldberg¹, Soyoun Rachel Kim², Rouhi Fazelzad³, Xuan Li⁴, Theodore J Brown⁵, Taymaa May⁶

Affiliations

¹ Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
² Division of Gynecologic Oncology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
³ Library and Information Services, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
⁴ Princess Margaret Cancer Centre, Biostatistics, Toronto, Ontario, Canada.
⁵ Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.
⁶ Division of Gynecologic Oncology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada. Electronic address: taymaa.may@uhn.ca.

PMID: 34756470
DOI: 10.1016/j.ygyno.2021.10.080

Abstract

Objectives: Low-grade serous ovarian cancer (LGSC) is a relatively chemo-resistant disease with limited effective treatment options for patients with recurrence. Secondary cytoreductive surgery (SCS) is commonly offered at recurrence, although any benefit this has on survival is not fully determined. This review evaluates the impact of SCS, including residual disease, on progression-free survival (PFS) and overall survival (OS) in recurrent LGSC.

Methods: A comprehensive search of Medline ALL, Embase Classic + Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Web of Science was conducted to obtain studies evaluating optimal or complete SCS versus suboptimal SCS and the amount of residual disease in recurrent LGSC. Meta-analysis was performed and PFS and OS outcomes were calculated.

Results: 1Of 5296 studies screened, 350 progressed to full-text review, with 9 ultimately selected for inclusion in the systematic review. Two studies met criteria for meta-analysis of PFS and of OS. The presence of visible residual disease at the conclusion of SCS negatively impacted PFS (HR = 3.51, 95% CI = 1.72-7.14), whereas SCS with no residual disease significantly improved OS (HR = 0.4, 95% CI = 0.23-0.7) in patients with recurrent LGSC. Diffuse and extensive disease distribution was inversely linked to survival. In addition, SCS as an initial treatment for recurrent LGSC was associated with superior survival in comparison to chemotherapy. A short platinum-free interval was not associated with worse survival in this cohort.

Conclusions: Complete SCS, and to a lesser extent optimal SCS, are associated with improved PFS and OS in patients with recurrent LGSC. SCS may be a better initial treatment strategy than systemic chemotherapy for recurrent disease. Patients with recurrent LGSC should be evaluated for the role of SCS based on disease distribution and functional status, irrespective of the platinum-free interval. Prospective studies are needed to further study the role of SCS in patients with recurrent LGSC.

Keywords: Low-grade serous ovarian cancer; meta-analysis; recurrent disease; residual disease; secondary surgical cytoreduction; survival.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Cystadenocarcinoma, Serous / pathology
Cystadenocarcinoma, Serous / surgery*
Cytoreduction Surgical Procedures
Female
Humans
Neoplasm Recurrence, Local / pathology
Neoplasm Recurrence, Local / surgery*
Ovarian Neoplasms / pathology
Ovarian Neoplasms / surgery*