Relationship between initiation time of adjuvant chemotherapy and survival in ovarian cancer patients: a dose-response meta-analysis of cohort studies.

Although several studies have previously investigated the association between the initiation time of adjuvant chemotherapy and survival in ovarian cancer, inconsistencies remain about the issue. We searched PubMed and Web of Science through the May 24, 2017 to identify cohort studies that investigated the aforementioned topic. Fourteen studies with 59,569 ovarian cancer patients were included in this meta-analysis. We conducted meta-analyses comparing the longest and shortest initiation time of adjuvant chemotherapy and dose-response analyses to estimate summary hazards ratios (HRs) and 95% confidence intervals (CIs). A random-effects model was used to estimate HRs with 95% CIs. When comparing the longest with the shortest category of initiation time of adjuvant chemotherapy, the summary HR was 1.18 (95% CI: 1.06–1.32; I 2 = 17.6; n = 7) for overall survival. Additionally, significant dose-response association for overall survival was observed for each week delay (HR = 1.04; 95% CI: 1.00–1.09; I 2 = 9.05; n = 5). Notably, these findings were robust in prospective designed cohort studies as well as studies with advanced stage (FIGO III-IV) patients. No evidence of publication bias was observed. In conclusion, prolonged initiation time of adjuvant chemotherapy is associated with a decreased overall survival rate of ovarian cancer, especially in patients with advanced stage ovarian cancer.

尽管此前已有多项研究探讨了卵巢癌辅助化疗起始时间与生存率之间的关联，但在这一问题上仍存在不一致之处。我们检索了截至2017年5月24日的PubMed和Web of Science，以确定研究上述主题的队列研究。这项荟萃分析纳入了14项研究，涉及59569名卵巢癌患者。我们进行了荟萃分析，比较了辅助化疗最长和最短起始时间，并进行了剂量 - 反应分析，以估算汇总风险比（HRs）和95%置信区间（CIs）。采用随机效应模型估算95%置信区间的风险比。在比较辅助化疗起始时间最长和最短类别时，总生存期的汇总风险比为1.18（95%置信区间：1.06 - 1.32；I² = 17.6；n = 7）。此外，观察到每延迟一周，总生存期存在显著的剂量 - 反应关联（风险比 = 1.04；95%置信区间：1.00 - 1.09；I² = 9.05；n = 5）。值得注意的是，这些发现在前瞻性设计的队列研究以及晚期（FIGO III - IV期）患者的研究中是稳健的。未观察到发表偏倚的证据。总之，辅助化疗起始时间延长与卵巢癌总生存率下降有关，尤其是在晚期卵巢癌患者中。