Surgical timing in advanced ovarian cancer during the TRUST trial era: A systematic review, meta-analysis and study-level meta-regression of randomized controlled trials
Year: 2025
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: The best surgical timing for advanced epithelial ovarian cancer, whether primary debulking surgery or interval debulking surgery, remains debated. Recent data, including the preliminary ones from TRUST trial, necessitates an updated critical evaluation. A systematic search of PubMed identified only randomized controlled trials comparing interval debulking surgery versus primary debulking surgery in patients with newly diagnosed advanced ovarian cancer. Primary outcomes included overall survival (OS) and progression-free survival (PFS). A random-effects meta-analysis, meta-regression, cumulative synthesis, and leave-one-out influence analysis were performed. A total of 2303 patients were included. Compared to primary debulking surgery, interval debulking surgery was associated with lower rates of postoperative complications (OR = 0.37; 95 % CI: 0.18-0.79; P = 0.01) and mortality (OR = 0.23; 95 % CI: 0.09-0.57; P = 0.002). Meta-analysis showed higher rates of complete cytoreduction with interval debulking surgery (OR = 3.84; 95 % CI: 2.14-6.91; P < 0.00001) and lower rates of macroscopic residual disease (OR = 0.20; 95 % CI: 0.13-0.30; P < 0.00001). Pooled data revealed no significant difference in OS (HR = 0.95; 95 % CI: 0.87-1.04; P = 0.26) or PFS (HR = 0.94; 95 % CI: 0.85-1.03; P = 0.16). Subgroup analyses by stage and residual disease confirmed similar survival outcomes. The meta-regression results suggested that even in trials with very high complete cytoreduction rates, no clinically meaningful OS benefit was observed for upfront surgery. In conclusion, interval debulking surgery offers comparable survival outcomes to primary debulking, with reduced perioperative morbidity and mortality, supporting its role as a valid surgical alternative. PROSPERO REGISTRATION NUMBER: CRD420251105308.
Authors: Veronica Tius, Cristina Taliento, Martina Arcieri, Sara Filippin, Miriam Isola, Maria De Martino, Nicolò Bizzarri, Matteo Pavone, Mauro Signorelli, Domenica Lorusso, Paolo Scollo, Sandro Pignata, Vito Chiantera, Giorgio Bogani, Jvan Casarin, Anna Fagotti, Stefano Restaino, Giuseppe Vizzielli
Institutions: University of Udine, Arcispedale Sant'Anna, Azienda sanitaria universitaria Friuli Centrale, Agostino Gemelli University Polyclinic, Istituti di Ricovero e Cura a Carattere Scientifico, IRCCS Humanitas Research Hospital, Università degli Studi di Enna Kore, Ospedale Cannizzaro, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Fondazione IRCCS Istituto Nazionale dei Tumori, University of Insubria, Ospedale Filippo Del Ponte Varese, University of Sassari, Ospedale Santa Maria della Misericordia di Udine
Language: English
Subfield: Reproductive Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,810
OpenAlex ID: W4417450124