Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.
Pan-Birmingham Gynaecological Oncology Cancer Centre, Birmingham, United Kingdom.
Am J Ther. 2023;30(1):e36-e55. doi: 10.1097/MJT.0000000000001584. Epub 2022 Dec 20.
We present a systematic review and network meta-analysis (NMA) that is the precursor underpinning the Bayesian analyses that adjust for publication bias, presented in the same edition in AJT. The review assesses optimal cytoreduction for women undergoing primary advanced epithelial ovarian cancer (EOC) surgery.
To assess the impact of residual disease (RD) after primary debulking surgery in women with advanced EOC. This review explores the impact of leaving varying levels of primary debulking surgery.
We conducted a systematic review and random-effects NMA for overall survival (OS) to incorporate direct and indirect estimates of RD thresholds, including concurrent comparative, retrospective studies of ≥100 adult women (18+ years) with surgically staged advanced EOC (FIGO stage III/IV) who had confirmed histological diagnoses of ovarian cancer. Pairwise meta-analyses of all directly compared RD thresholds was previously performed before conducting this NMA, and the statistical heterogeneity of studies within each comparison was evaluated using recommended methods.
Twenty-five studies (n = 20,927) were included. Analyses demonstrated the prognostic importance of complete cytoreduction to no macroscopic residual disease (NMRD), with a hazard ratio for OS of 2.0 (95% confidence interval, 1.8-2.2) for <1 cm RD threshold versus NMRD. NMRD was associated with prolonged survival across all RD thresholds. Leaving NMRD was predicted to provide longest survival (probability of being best = 99%). The results were robust to sensitivity analysis including only those studies that adjusted for extent of disease at primary surgery (hazard ratio 2.3, 95% confidence interval, 1.9-2.6). The overall certainty of evidence was moderate and statistical adjustment of effect estimates in included studies minimized bias.
The results confirm a strong association between complete cytoreduction to NMRD and improved OS. The NMA approach forms part of the methods guidance underpinning policy making in many jurisdictions. Our analyses present an extension to the previous work in this area.
我们进行了一项系统评价和网络荟萃分析（NMA），这是为在同一期 AJT 中呈现的针对发表偏倚进行调整的贝叶斯分析提供的基础。该综述评估了女性接受原发性晚期上皮性卵巢癌（EOC）手术时的最佳减瘤术。
评估原发性去瘤手术后残余疾病（RD）对晚期 EOC 女性的影响。本综述探讨了残留疾病水平对原发性去瘤手术的影响。
我们进行了一项系统评价和随机效应 NMA，以评估总体生存率（OS），以纳入 RD 阈值的直接和间接估计值，包括≥ 100 名接受手术分期的晚期 EOC（FIGO 分期 III/IV）的成人女性（18 岁以上）的同期比较、回顾性研究，这些患者均经组织学诊断为卵巢癌。在进行 NMA 之前，我们对所有直接比较的 RD 阈值进行了两两荟萃分析，并使用推荐的方法评估了每个比较中研究的统计异质性。
共纳入 25 项研究（n = 20927）。分析表明，完全去瘤至无显微镜下残留疾病（NMRD）对预后至关重要，RD 阈值<1cm 时的 OS 风险比为 2.0（95%置信区间，1.8-2.2），与 NMRD 相比。NMRD 与所有 RD 阈值的生存延长相关。残留 NMRD 被预测为提供最长的生存（最佳概率为 99%）。结果在包括仅调整原发性手术疾病范围的研究的敏感性分析中仍然稳健（风险比 2.3，95%置信区间，1.9-2.6）。证据的总体确定性为中等，纳入研究中对效应估计值的统计调整最大限度地减少了偏倚。
结果证实了完全去瘤至 NMRD 与改善 OS 之间存在强烈关联。NMA 方法是许多司法管辖区制定政策的方法指导的一部分。我们的分析是该领域先前工作的扩展。
