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. 2022 Sep 26;2022(9):CD015048. doi: 10.1002/14651858.CD015048.pub2

Summary of findings 7. Residual disease (RD) > 0 cm versus NMRD in IDS studies.

Any remaining residual disease (RD) (> 0 cm) compared with NMRD after primary interval debulking surgery (IDS) in women with advanced epithelial ovarian cancer (EOC)
Population: women with advanced EOC after primary IDS
Settings: all settings in adult women aged 18 years or older worldwide
Prognostic factor: RD > 0 cm compared with NMRD
Outcomes Relative effect
(95% CI) No of participants
(studies) Quality of the evidence
(GRADE) Comments
Overall survival:
Median length of follow‐up: range: 37 to 39 (reported in 2 studies)
Adjusted HR 2.11 (1.35 to 3.29) 906 participants
(4 studies) ⊕⊝⊝⊝
very low123 We could not present illustrative absolute effects because a representative control group risk could not be ascertained from the studies. The HR estimates were adjusted for in multivariable analyses and this cannot be done in absolute terms, so we did not attempt it as the numbers were likely to mislead with any bias potentially favouring the NMRD threshold.
The percentage of the variability in effect estimates that was due to heterogeneity rather than chance may represent considerable heterogeneity (I2 = 81%).
The authors of Lecuru 2019 additionally found that the risk of death for women with any remaining RD (> 0 cm) after IDS was significantly higher than those with NMRD (n = 163, P < 0.01), but the magnitude of effect was not reported.
Progression‐free survival:
Median length of follow‐up: not reported
Adjusted HR 1.36 (1.05 to 1.76) 471 participants
(1 study) ⊕⊝⊝⊝
very low123 The authors of Lecuru 2019 additionally found that the risk of disease progression for women with RD > 0 cm after IDS was significantly higher than those with NMRD (n = 163, P < 0.01), but the magnitude of effect was not reported.
CI: confidence interval; HR: hazard ratio; EOC: epithelial ovarian cancer; IDS: interval debulking surgery; NMRD: no macroscopic residual disease; OS: overall survival; PDS: upfront primary debulking surgery; PFS: progression‐free survival
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.

1Downgraded by one level because we assessed the statistical analysis and reporting domain in the QUIPS tool as being at high or unclear risk of bias in all included studies. Either no conceptual framework was reported, where the variable selection criteria in multivariate model was unclear, or quite often the authors reported that significant variables from the univariate analysis were included in the multivariable model, but with no further details. This was the most serious bias from the QUIPS domains that could influence the effect estimates.

2Downgraded by one level for heterogeneity across studies.

3Downgraded by one level for lack of generalisability and validity of results as reported in single analysis or very few included studies.