Cochrane · systematic review · CD005343
Neoadjuvant chemotherapy before surgery versus surgery followed by chemotherapy for initial treatment in advanced ovarian epithelial cancer
Coleridge, SL, Bryant, A, Kehoe, S, et al. · Cochrane Database of Systematic Reviews · 2021 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
7
current version
GRADE rated
7
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 1 · 14.3%Low 0 · 0%Moderate 4 · 57.1%High 2 · 28.6%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyNeoadjuvant chemotherapy prior to interval surgery (NACT) compared to surgery followed by chemotherapy (PDS) for initial treatment in advanced ovarian epithelial cancer
Population: women with advanced ovarian epithelial cancer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survival ( Neoadjuvant chemotherapy prior to interval surgery (NACT) vs surgery followed by chemotherapy (PDS) | HR 0.96 [0.86, 1.08] | 4 studies · 2000 participants | High |
Progression‐free survival ( Neoadjuvant chemotherapy prior to interval surgery (NACT) vs surgery followed by chemotherapy (PDS) | HR 0.98 [0.88, 1.08] | 4 studies · 1847 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Surgically‐related severe adverse effects (grade 3+) ‐ stoma formation (within 30 days of surgery) Neoadjuvant chemotherapy prior to interval surgery (NACT) vs surgery followed by chemotherapy (PDS) | RR 0.29 [0.12, 0.74] | 2 studies · 632 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Surgically‐related severe adverse effects (grade 3+) ‐ bowel resection (within 30 days of surgery) Neoadjuvant chemotherapy prior to interval surgery (NACT) vs surgery followed by chemotherapy (PDS) | RR 0.49 [0.3, 0.79] | 4 studies · 1565 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Surgically‐related severe adverse effects (grade 3+) ‐ postoperative G3+ events (within 30 days of surgery) Neoadjuvant chemotherapy prior to interval surgery (NACT) vs surgery followed by chemotherapy (PDS) | RR 0.22 [0.13, 0.38] | 2 studies · 435 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Surgically‐related postoperative mortality (28 days to 6 months of surgery4) Neoadjuvant chemotherapy prior to interval surgery (NACT) vs surgery followed by chemotherapy (PDS) | RR 0.16 [0.06, 0.46] | 5 studies · 1623 participants | High |
EORTC QLQ‐C30 QoL at 6 months ‐ global health Neoadjuvant chemotherapy prior to interval surgery (NACT) vs surgery followed by chemotherapy (PDS) | no estimate extracted | 3 studies · 524 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Summary of findings
Population: women with advanced ovarian epithelial cancer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survival | HR 0.95 [0.84, 1.07] | 3 studies · 1521 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Progression‐free survival | HR 0.97 [0.87, 1.07] | 4 studies · 1631 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Severe adverse effects (grade 3+): Need for blood transfusion | RR 0.8 [0.65, 0.99] | 4 studies · 1085 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Severe adverse effects (grade 3+): Venous thromboembolism | RR 0.28 [0.09, 0.9] | 4 studies · 1490 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Severe adverse effects (grade 3+): Infection | RR 0.3 [0.16, 0.56] | 4 studies · 1490 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Stoma formation | RR 0.43 [0.26, 0.72] | 2 studies · 581 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Bowel resection | RR 0.49 [0.26, 0.92] | 3 studies · 1213 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Postoperative mortality within 30 days | RR 0.18 [0.06, 0.54] | 5 studies · 1571 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Quality of life (QoL) at 6 months | MD 7.6 | 3 studies · 524 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Comparison
Population: women with advanced ovarian epithelial cancer
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survival | HR 1.06 [0.94, 1.19] | 3 studies · 1521 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Progression‐free survival | HR 1.02 [0.92, 1.13] | 4 studies · 1631 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Severe adverse effects (grade 3+): Need for blood transfusion | RR 0.8 [0.65, 0.99] | 4 studies · 1490 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Severe adverse effects (grade 3+): Venous thromboembolism | RR 0.28 [0.09, 0.9] | 4 studies · 1490 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Severe adverse effects (grade 3+): Infection | RR 0.3 [0.16, 0.56] | 4 studies · 1490 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Stoma formation | RR 0.43 [0.26, 0.72] | 2 studies · 581 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Bowel resection | RR 0.49 [0.26, 0.92] | 3 studies · 1213 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Postoperative mortality within 30 days | RR 0.18 [0.06, 0.54] | 5 studies · 1571 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency |
Quality of life (QoL) at 6 months | MD 7.6 | 3 studies · 524 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |