A meta-analysis on the impact of platinum-based adjuvant treatment on the outcome of borderline ovarian tumors with invasive implants

Oncologist. 2015 Feb;20(2):151-8. doi: 10.1634/theoncologist.2014-0144. Epub 2015 Jan 19.

Abstract

Background: Treatment of borderline ovarian tumors (BOTs) remains contentious, and there is no consensus regarding therapy for BOTs with invasive implants (BOTi). The benefits of platinum-based adjuvant treatment were evaluated in patients with BOTi at primary diagnosis.

Methods: The PubMed database was systematically searched for articles using the following terms: ((borderline) OR (low malignant potential) AND (ovarian)) AND ((tumor) OR (cancer)) AND (invasive implants) AND ((follow-up) OR (survival) OR (treatment) OR (chemotherapy) OR (adjuvant treatment) OR (surgery) OR (surgical treatment)).

Results: We identified 27 articles including 3,124 patients, 181 with invasive implants. All studies provided information regarding mortality or recurrence rates. Central pathological examination was performed in 19 studies. Eight studies included more than 75% stage I patients; 7 included only advanced-stage patients, and 14 included only serous BOT. The pooled recurrence estimates for both treatment groups (adjuvant treatment: 44.0%, upfront surgery: 21.3%) did not differ significantly (p = .114). A meta-analysis of the 6 studies providing separate mortality data for both treatment groups favored surgical treatment only, but this difference did not reach statistical significance (.05 < p < .1; odds ratio: 0.33; 95% confidence interval: 0.09-1.71; p = .086). We were unable to pool the results of the included studies because not all studies registered events in both treatment groups. Egger's regression indicated low asymmetry of the studies (p = .39), and no heterogeneity was found (I(2) = 0%).

Conclusion: We did not find evidence supporting platinum-based adjuvant therapy for BOT with invasive implants.

背景. 目前对卵巢交界性肿瘤(BOT)的治疗仍存有争议,有关 BOT 伴浸润性种植(BOTi)的治疗也未达成共识。本研究在首次诊断为 BOTi 的患者中对以铂类为基础的辅助治疗的获益进行了评价。

方法. 我们使用下列检索词在 PubMed 数据库中对文献进行了系统性检索:((交界性)或(低度恶性潜能)和(卵巢))和((肿瘤)或(癌症))和(浸润性种植)和((随访)或(生存)或(治疗)或(化疗)或(辅助治疗)或(外科)或(外科手术治疗))。

结果. 共纳入 27 篇文献,包括 3 124 例患者,其中 181 例伴有浸润性种植。所有研究都有死亡率或复发率数据。19 项研究进行了中心实验室病理检查,8 项研究纳入的 I 期患者比例> 75%,7 项研究只纳入了进展期患者,14 项研究只纳入浆液性 BOT 患者。两个治疗组的汇总复发估算值(辅助治疗:44.0%,一期手术:21.3%)无显著差异(P=0.114)。对 6 项有两个治疗组单独死亡率数据的研究进行了 meta 分析,结果显示有利于仅手术治疗,但差异无统计学意义(0.05 < P < 0.1,比值比:0.33;95%可信区间:0.09 ∼ 1.71;P = 0.086)。由于并非所有的研究都记录了两个治疗组的事件,因此无法汇总所有纳入研究的结果。Egger 回归分析显示了低不对称性(P = 0.39),但无异质性(I2 = 0%)。

结论. 我们没有发现支持以铂类为基础的辅助治疗用于BOT伴浸润性种植的证据。The Oncologist 2015;20:151–158

Keywords: Adjuvant treatment; Borderline ovarian tumors; Chemotherapy; Implants; Platinum-based treatment.

Publication types

  • Meta-Analysis

MeSH terms

  • Chemotherapy, Adjuvant*
  • Combined Modality Therapy
  • Cystadenocarcinoma, Serous / drug therapy*
  • Cystadenocarcinoma, Serous / pathology
  • Drug Implants / adverse effects
  • Female
  • Humans
  • Neoplasm Recurrence, Local / drug therapy*
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Staging
  • Ovarian Neoplasms / drug therapy*
  • Ovarian Neoplasms / pathology
  • Platinum / administration & dosage
  • Treatment Outcome

Substances

  • Drug Implants
  • Platinum