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What have we learnt from meta-analyses in ovarian cancer?
S B Kaye1, H C van Houwelingen
1CRC Department of Medical Oncology, Beatson Oncology Centre, Western Infirmary, Glasgow, UK.
Background:
Meta-analyses aim to provide an overview of certain key questions such as optimal chemotherapy, dose-response relationships, and factors predicting long-term survival.
Materials And Methods:
A review was done of recently published meta-analyses trying to answer the above questions.
Results:
Two studies suggest that platinum containing combination chemotherapy is superior with regard to survival. Both show the limitation of all meta-analyses with variations in terms of follow-up and in trial details, and the conclusions must be regarded as tentative. Prospective studies which have attempted to confirm the importance of cisplatin dose-intensity (as opposed to total dose) have actually failed to do so. Two meta-analyses found a strong correlation between surgical complete response and survival. In a Dutch long-term follow-up study of about 400 cases cisplatin combination, pathologically documented complete remission, optimal debulking, and grade all were associated with a significant survival benefit. The results of other analyses, suggesting that the treatment centre involved, and adherence to study protocols, are independent prognostic factors are particularly provocative.
Conclusions:
Recognizing their limitations, meta-analyses are intended to stimulate ideas for future trials and as such have a positive impact.