title: Survival impact of complete cytoreduction to no gross residual disease for advanced-stage ovarian cancer: a meta-analysis.
abstract: OBJECTIVE
  To quantify the impact of complete cytoreduction to no gross residual disease on overall survival among patients with advanced-stage ovarian cancer treated during the platinum-taxane era.
  
  
  METHODS
  PubMed and Cochrane Library databases were searched for all articles on primary cytoreductive surgery for advanced-stage ovarian cancer published from 1/1996 to 7/2011. A total of 18 relevant studies (13,257 patients) were identified for analysis. Simple and multiple linear regression analyses, with weighted correlation calculations, were used to assess the effect on median survival time of clinical and treatment-related factors.
  
  
  RESULTS
  The mean weighted median overall survival time for all cohorts was 44.4 months (range, 27.6-66.9 months). Simple linear regression analysis revealed that residual disease, stage IV disease, and use of intraperitoneal chemotherapy were significantly associated with median survival time. After controlling for other factors on multiple linear regression analysis, each 10% increase in the proportion of patients undergoing complete cytoreduction to no gross residual disease was associated with a significant and independent 2.3-month increase (95%CI = 0.6-4.0, p = 0.011) in cohort median survival compared to a 1.8-month increase (95%CI = 0.6-3.0, p = 0.004) in cohort median survival for optimal cytoreduction (residual disease≤1cm). Each 10% increase in the proportion of patients receiving intraperitoneal chemotherapy was associated with a significant and independent 3.9-month increase (95%CI = 1.1-6.8, p=0.008) in median cohort survival time.
  
  
  CONCLUSIONS
  For advanced-stage ovarian cancer treated during the platinum-taxane era, the proportions of patients left with no gross residual disease and receiving intraperitoneal chemotherapy are independently significant factors associated with the most favorable cohort survival time.
authors.affiliation: Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Republic of Korea.
authors.forename: Suk-Joon
authors.initials: SJ
authors.lastname: Chang
authors.forename: Melissa
authors.initials: M
authors.lastname: Hodeib
authors.forename: Jenny
authors.initials: J
authors.lastname: Chang
authors.forename: Robert E
authors.initials: RE
authors.lastname: Bristow
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001952:Bridged-Ring Compounds / Q000008:administration & dosage; D002277:Carcinoma / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D017671:Platinum Compounds / Q000008:administration & dosage; D016019:Survival Analysis; D043823:Taxoids / Q000008:administration & dosage
chemical_list: D001952:Bridged-Ring Compounds; D017671:Platinum Compounds; D043823:Taxoids; C080625:taxane
keywords: Advanced ovarian cancer; Complete cytoreduction; Residual disease