Ovarian cancer: is adjuvant chemotherapy needed for all early-stage disease?

  • Bogani G & al.
  • Gynecol Oncol
  • 21 Jan 2020

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • In patients with early-stage clear cell ovarian cancer, adjuvant chemotherapy does not improve OS in the overall population, but extends OS in those with stage IC.

Why this matters

  • International guidelines recommended adjuvant chemotherapy regardless of stage and histological classification.
  • Meta-analysis shows stage IA/B patients do not derive a survival benefit from adjuvant chemotherapy.

Study design

  • A meta-analysis of 7 studies including 5073 patients with stage I clear cell ovarian cancer.
  • Funding: None.

Key results

  • Median follow-up ranged from 30 months to 6.21 years.
  • 72.5% of patients received adjuvant chemotherapy.
  • Overall, 5-year disease-free survival (DFS) and OS were 83.7% and 86.9%, respectively.
  • Overall, adjuvant chemotherapy vs observation yielded no statistical difference in:
    • 5-year DFS: 83.3% vs 84.4% (risk difference, 0.01; P=.86).
    • 5-year OS: 88.4% vs 84.7% (risk difference, 0.85; P=.53).
  • In patients with stage IC disease, significant improvement in OS was seen with adjuvant chemotherapy vs observation (OR, 0.70; P=.01).

Limitations

  • All included studies were retrospective.
  • Heterogeneity across studies.