title: Trends in Mortality After Primary Cytoreductive Surgery for Ovarian Cancer: A Systematic Review and Metaregression of Randomized Clinical Trials and Observational Studies.
abstract: BACKGROUND
  Primary cytoreductive surgery (PDS) followed by platinum-based chemotherapy is the cornerstone of treatment and the absence of residual tumor after PDS is universally considered the most important prognostic factor. The aim of the present analysis was to evaluate trend and predictors of 30-day mortality in patients undergoing primary cytoreduction for ovarian cancer.
  
  
  METHODS
  Literature was searched for records reporting 30-day mortality after PDS. All cohorts were rated for quality. Simple and multiple Poisson regression models were used to quantify the association between 30-day mortality and the following: overall or severe complications, proportion of patients with stage IV disease, median age, year of publication, and weighted surgical complexity index. Using the multiple regression model, we calculated the risk of perioperative mortality at different levels for statistically significant covariates of interest.
  
  
  RESULTS
  Simple regression identified median age and proportion of patients with stage IV disease as statistically significant predictors of 30-day mortality. When included in the multiple Poisson regression model, both remained statistically significant, with an incidence rate ratio of 1.087 for median age and 1.017 for stage IV disease. Disease stage was a strong predictor, with the risk estimated to increase from 2.8% (95% confidence interval 2.02-3.66) for stage III to 16.1% (95% confidence interval 6.18-25.93) for stage IV, for a cohort with a median age of 65 years.
  
  
  CONCLUSIONS
  Metaregression demonstrated that increased age and advanced clinical stage were independently associated with an increased risk of mortality, and the combined effects of both factors greatly increased the risk.
authors.affiliation: Department of Gynecology Obstetrics and Urology, Policlinico Umberto I, ''Sapienza'' University of Rome, Rome, Italy. violante.didonato@uniroma1.it.
authors.forename: Violante
authors.initials: V
authors.lastname: Di Donato
authors.affiliation: The Farr Institute for Health Informatics Research, University of Manchester, Manchester, UK.|The National Institute for Health Research, School for Primary Care Research, Radcliffe Observatory Quarter, Oxford, UK.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Kontopantelis
authors.affiliation: Division of Medical Gynecologic Oncology, European Institute of Oncology, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Aletti
authors.affiliation: Department of Gynecology Obstetrics and Urology, Policlinico Umberto I, ''Sapienza'' University of Rome, Rome, Italy.
authors.forename: Assunta
authors.initials: A
authors.lastname: Casorelli
authors.affiliation: Department of Gynecology Obstetrics and Urology, Policlinico Umberto I, ''Sapienza'' University of Rome, Rome, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Piacenti
authors.affiliation: Gynecologic Surgery Unit, IRCCS Foundation, National Cancer Institute, Milan, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bogani
authors.affiliation: Department of Gynecology Obstetrics and Urology, Policlinico Umberto I, ''Sapienza'' University of Rome, Rome, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Lecce
authors.affiliation: Department of Gynecology Obstetrics and Urology, Policlinico Umberto I, ''Sapienza'' University of Rome, Rome, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Benedetti Panici
mesh_terms: D065426:Cytoreduction Surgical Procedures / Q000401:mortality*; D005260:Female; D006801:Humans; D009026:Mortality / Q000639:trends*; D064887:Observational Studies as Topic; D010051:Ovarian Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate