WHAT HAVE WE LEARNT FROM METAANALYSES IN OVARIAN-CANCER

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.