Impact van chirurgische stadiëring op prognose bij borderline ovariumtumoren: meta-analyse

BACKGROUND: To quantify the effect of complete surgical staging (CSS) on prognosis in borderline ovarian tumour (BOT) patients through a meta-analysis. METHODS: We systematically reviewed published studies comparing CSS with incomplete surgical staging (ISS) in BOT patients through April 2015. End-points were recurrence and mortality rates. Study design features that possibly affected participant selection, recurrence/death detection, and manuscript publication were assessed. For pooled estimates of the effect of CSS on recurrence/death, random- or fixed-effects meta-analytical models were used after assessing cross-study heterogeneity. RESULTS: Eighteen observational studies (CSS, 1297 patients; ISS, 1473 patients) met our search criteria. Fixed-effects model-based meta-analysis indicated a reduced recurrence risk among CSS patients (odds ratio [OR]=0.64; 95% confidence interval [CI]: 0.47-0.87, P < 0.05, I(2) = 25.6). However, no significant between-group difference in mortality was observed (OR = 0.98; 95% CI: 0.42-2.29, P = 0.97, I(2) = 0). In subgroup analysis by histology, CSS was associated with a reduced recurrence risk in 16 studies of all histologic types (OR = 0.66; 95% CI: 0.48-0.91, P < 0.05, I(2) = 31.9) but not in two studies of only mucinous disease (OR = 0.41; 95% CI: 0.13-1.30, P = 0.13, I(2) = 0). In subgroup analyses with four studies with recurrence data according to fertility-sparing surgery, no significant association was found (OR = 0.51; 95% CI: 0.18-1.43, P = 0.20, I(2) = 0). There was no evidence of publication bias. CONCLUSIONS: In this meta-analysis based on observational studies, CSS appeared to significantly reduce recurrence among BOT patients. No survival impact was observed. Longer-term randomised controlled trials could verify this relationship but appear infeasible for this rare tumour.