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Adjuvant Chemotherapy in Stage I Ovarian Clear Cell Carcinoma: A Systematic Review and Meta-analysis
Yoshihide Inayama1, Nozomi Higashiyama, Ken Yamaguchi
1Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, the Department of Obstetrics and Gynecology, National Hospital Organization Kyoto Medical Center, and the Graduate School of Medicine and Public Health and the Office of Institutional Advancement and Communications, Kyoto University, Kyoto; the Department of Obstetrics and Gynecology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, the Department of Obstetrics and Gynecology, Osaka Saiseikai Noe Hospital, Osaka, and the Department of Obstetrics and Gynecology, Kurashiki Central Hospital, Okayama, Japan.
Objective:
To investigate the treatment effect of adjuvant chemotherapy for stage I ovarian clear cell carcinoma.
Data Sources:
We searched Cochrane, PubMed, International Standard Randomised Controlled Trial Number registry, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, and Ichushi-Web to January 22, 2025.
Methods Of Study Selection:
We included randomized controlled trials (RCTs) and non-RCTs that included more than 50 patients with stage I ovarian clear cell carcinoma. The primary and secondary outcomes were disease-free survival and overall survival, respectively. We performed a meta-analysis of the stage-adjusted hazard ratios (HRs) of adjuvant chemotherapy compared with placebo or no intervention. The substage-related heterogeneity of effects was also assessed. A meta-analysis of proportions was also conducted to assess 5-year disease-free survival and 5-year overall survival. Risk of bias was assessed with the Risk of Bias in Non-randomized Studies of Interventions tool.
Tabulation, Integration, And Results:
Because no RCTs reported HRs for the ovarian clear cell carcinoma subgroup, data from nine non-RCTs were analyzed. The pooled substage-adjusted HR for disease-free survival associated with use of chemotherapy was 0.47 (95% CI, 0.29-0.74) and that for overall survival was 0.66 (95% CI,0.43-1.00). Heterogeneity in the effect by substage was not evident for either disease-free survival (P for subgroup difference=.91) or overall survival (P=.60). The pooled 5-year disease-free survival was 0.80 (95% CI, 0.65-0.89) for stage I overall, 0.95 (95% CI, 0.47-1.0) for stage IA, and 0.61 (95% CI, 0.47-0.74) for stage IC. The estimated number needed to treat was 10.2 (95% CI, 5.8-18.6) for stage I overall, 40.8 (95% CI, 3.9-infinity) for stage IA, and 5.2 (95% CI, 3.9-7.8) for stage IC.
Conclusion:
Adjuvant chemotherapy improves disease-free survival and may prolong overall survival in patients with stage I ovarian clear cell carcinoma. Available evidence suggests that recurrence is reduced by approximately 50%. Treatment decisions should consider the baseline recurrence risks and absolute benefits.
Clinical Trial Registration:
PROSPERO, CRD42024562486.
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