Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis
Phase meta-analysisN = 6,885
- Population
- Cohorts of patients with stage III or IV ovarian carcinoma treated with platinum-based chemotherapy
- Design
- Cohort-level meta-analysis. Eighty-one cohorts of patients with stage III or IV ovarian carcinoma (6,885 patients) were identified from MEDLINE articles (1989 through 1998). Linear regression models with weighted correlation calculations assessed the effect on log median survival time of the proportion of each cohort undergoing maximal cytoreduction, platinum dose-intensity, proportion with stage IV disease, median age and year of publication. Each comparison is between groups of published cohorts, not between randomised patients.
- Arms
- Cohorts with 25% or less maximal cytoreduction (control): Cohorts in which 25% or less of patients had maximal cytoreduction, followed by platinum-based chemotherapy
- Cohorts with more than 75% maximal cytoreduction (experimental): Cohorts in which more than 75% of patients had maximal cytoreduction, followed by platinum-based chemotherapy
- People
- Bristow RE
Δ median OS+11.2 months
Show the numbers
| Endpoint | Analysis | Cohorts with more than 75% maximal cytoreduction | Cohorts with 25% or less maximal cytoreduction | Effect |
|---|---|---|---|---|
| OSCohort-level analysis of 81 published cohorts (6,885 patients); not patient-level | primaryBristow 2002 | median 33.9 months | median 22.7 months | P<.001Values are mean weighted median survival times of cohorts, estimated from actuarial survival. The P value (<.001) belongs to the regression of log median survival time on the proportion of maximal cytoreduction, which remained significant after controlling for the other variables; each 10% increase in maximal cytoreduction was associated with a 5.5% increase in median survival time. Platinum dose-intensity was not significantly related to survival. |
| Endpoint | Analysis | Cohorts with more than 75% maximal cytoreduction | Cohorts with 25% or less maximal cytoreduction | Effect |
|---|---|---|---|---|
| OSCohort-level analysis of 81 published cohorts (6,885 patients); not patient-level | primaryBristow 2002 | median 33.9 months | median 22.7 months | P<.001Values are mean weighted median survival times of cohorts, estimated from actuarial survival. The P value (<.001) belongs to the regression of log median survival time on the proportion of maximal cytoreduction, which remained significant after controlling for the other variables; each 10% increase in maximal cytoreduction was associated with a 5.5% increase in median survival time. Platinum dose-intensity was not significantly related to survival. |
- Cohorts with 25% or less maximal cytoreduction (control)
- Cohorts with more than 75% maximal cytoreduction (experimental)
Median-only curves assume a constant hazard (exponential) and fit plateaus, as seen with some immunotherapies, poorly.
Data table (modelled values)
| Months | Cohorts with 25% or less maximal cytoreduction | Cohorts with more than 75% maximal cytoreduction |
|---|---|---|
| 0 | 100.0% | 100.0% |
| 21 | 52.7% | 65.1% |
| 42 | 27.7% | 42.4% |
| 64 | 14.2% | 27.0% |
| 85 | 7.5% | 17.6% |