Summary of findings 1. Summary of findings.
| Neoadjuvant chemotherapy compared with primary debulking surgery for advanced ovarian epithelial cancer | |||||
|
Women or population: women with advanced ovarian epithelial cancer Settings: hospital‐based care in countries including Algeria, Argentina, Austria, Belgium, Canada, Ireland, Italy, Japan, Norway, the Netherlands, Portugal, Spain, Sweden, the UK and New Zealand Intervention: platinum‐based chemotherapy followed by debulking surgery (neoadjuvant chemotherapy) Comparison: primary debulking surgery followed by platinum‐based chemotherapy (adjuvant chemotherapy) | |||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | |
| Assumed risk | Corresponding risk | ||||
| PDS | NACT | ||||
| Overall survival | We could not present illustrative absolute effects because a representative control group risk could not be ascertained from the studies or from any reliable external source. | HR 0.95 (0.84 to 1.07) | 1521 participants (3 studies) | ⊕⊕⊕⊝ moderate1 | |
| Progression‐free survival | HR 0.97 (0.87 to 1.07) | 1631 participants (4 studies) | ⊕⊕⊕⊝ moderate1 | ||
| Severe adverse effects (grade 3+): Need for blood transfusion | 9 per 1000 |
7 per 1000 (6 to 9) |
RR 0.80 (0.65 to 0.99) | 1085 participants (4 studies) | ⊕⊕⊝⊝ low1, 2 |
| Severe adverse effects (grade 3+): Venous thromboembolism | 32 per 1000 | 9 per 1000 (3 to 29) |
RR 0.28 (0.09 to 0.90) for venous thromboembolism |
1490 participants (4 studies) | ⊕⊕⊝⊝ low1, 2 |
| Severe adverse effects (grade 3+): Infection | 60 per 1000 | 18 per 1000 (10‐34) | RR 0.30 (0.16 to 0.56) | 1490 participants (4 studies) | ⊕⊕⊕⊝ moderate1 |
| Stoma formation | 146 per 1000 | 64 per 1000 (39 to 107) | RR 0.43 (0.26 to 0.72) | 581 participants (2 studies) | ⊕⊕⊕⊝ moderate1 |
| Bowel resection | 158 per 1000 | 77 per 1000 (41 to 145) | RR 0.49 (0.26 to 0.92) | 1213 participants (3 studies) | ⊕⊕⊕⊝ moderate1 |
| Postoperative mortality within 30 days | 31 per 1000 | 6 per 1000 (2 to 17) | RR 0.18 (0.06 to 0.54) | 1571 participants (5 studies) | ⊕⊕⊕⊝ moderate1 |
| Quality of life (QoL) at 6 months | QoL on the EORTC QLQ‐C30 scale produced inconsistent and imprecise results in two studies (MD ‐1.34, 95% CI ‐2.36 to ‐0.32; participants = 307) and use of the QLQC‐30 and QLQC‐Ov28 in another study (MD 7.60, 95% CI 1.89 to 13.31; participants = 217) meant that little could be inferred. Reported descriptively due to inconsistencies, heterogeneity and high attrition |
524 participants (3 studies) | ⊕⊝⊝⊝ verylow1,2,3 | ||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; HR: Hazard Ratio; RR: Risk Ratio. | |||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | |||||
1 Downgraded by 1 level due to concerns about overall risk of bias 2 Downgraded by 1 level due to concerns about imprecision 3 Downgraded by 1 level due to inconsistencies in results and general heterogeneity