Impact of postoperative residual disease in patients with primary epithelial ovarian cancer in the era of maintenance therapies with targeted agents: A systematic review and meta-analysis.

person Ji Hyun Kim National Cancer Center Korea, Goyang, South Korea info_outline Ji Hyun Kim, Se Ik Kim, Eun Young Park, Hyeong In Ha, Jae-Weon Kim, Robert L. Coleman, Robert E. Bristow, Sang-Yoon Park, Christina Fotopoulou, Myong Cheol Lim

Authors person Ji Hyun Kim National Cancer Center Korea, Goyang, South Korea info_outline Ji Hyun Kim, Se Ik Kim, Eun Young Park, Hyeong In Ha, Jae-Weon Kim, Robert L. Coleman, Robert E. Bristow, Sang-Yoon Park, Christina Fotopoulou, Myong Cheol Lim Organizations National Cancer Center Korea, Goyang, South Korea, Seoul National University College of Medicine, Seoul, South Korea, National Cancer Center, Korea, Goyang, South Korea, Pusan National University Yangsan Hospital, Yangsan-Si, Gyeongsangnam-Do, South Korea, Seoul National University Hospital, Seoul, South Korea, US Oncology Research, The Woodlands, TX, University of California Irvine Department of Psychiatry and Human Behavior, Orange, CA, National Cancer Center, Goyang-Si, South Korea, Imperial College London, London, United Kingdom, Center for Gynecologic Cancer, National Cancer Center, Ilsandong-Gu, Goyang-Si, South Korea Abstract Disclosures Research Funding Institutional Funding National Cancer Center Korea Background: To investigate the impact of residual disease after cytoreductive surgery for epithelial ovarian cancer (EOC) on survival outcomes in the era of targeted maintenance approaches, including bevacizumab and poly (ADP-ribose) polymerase (PARP) inhibitor administration. Methods: We searched relevant literature from the MEDLINE, Embase, and Cochrane Library databases to identify randomized controlled trials and prospective clinical trials of primary EOC published between 1 January 2000 and 22 September 2022. To evaluate the impact of postoperative residual tumors on PFS and OS, we constructed a linear regression model for log-transformed median progression-free survival (PFS) and overall survival (OS). Patients with and without first-line maintenance therapy were examined. The protocol was registered in the PROSPERO (CRD42021265810). Results: In total, 97 trials with 41,799 patients were included: 2476 received PARP inhibitors, and 6920 received bevacizumab. The median rate of complete cytoreduction was 36.3% (range, 0–99.4%), regardless of the timing of surgery. Multivariable analysis of the linear regression model of all studies revealed that the median OS increased by 12.97% for every 10% increase in complete cytoreduction rates, independently of the use of systemic maintenance. In subgroup analysis of patients with maintenance therapies, the effect of complete tumor clearance was potentiated, with a median OS increased by 19.13% for every 10% increase in complete cytoreduction rates. The previously described significant effect of total macroscopic tumor clearance of PFS could not be retained when adjusting for maintenance treatment. Conclusions: Total macroscopic tumor clearance at the initial presentation of EOC significantly prolongs OS. Our results establish the importance of complete surgical cytoreduction in the era of novel targeted systemic agents.