新辅助化疗（NACT）是晚期上皮性卵巢癌（AEOC）患者中不适宜进行原发减灶手术的一种治疗选择。通常，手术前3个周期的化疗被认为是患者生存的最佳选择，尽管很多患者接受了超过3个周期的化疗。本系统评价和荟萃分析的目的是确定在AEOC患者中报告更好生存的最佳NACT周期数。我们检索了PubMed、Cochrane图书馆和Scopus以寻找分析AEOC患者在间隔减灶手术（IDS）之前的化疗周期数与临床结果之间关系的原始文章。主要结果指标是无进展生存期（PFS）和总生存期（OS）。共有22项研究纳入了我们的分析，包括7,005名被诊断为AEOC的患者。在生存方面，通过将患者分为≤3个NACT周期和>3个周期，回顾性研究显示，化疗周期数的增加与PFS的减少以及OS的显著降低呈相关趋势；然而，如果早期IDS包括接受4个NACT周期化疗的患者，则PFS和OS均存在差异。鉴于AEOC患者的复杂特征，对这些结果需要谨慎解读。总之，我们的评价和荟萃分析表明，目前没有足够的证据确定手术前NACT治疗的最佳周期数。需要进一步进行设计良好的随机对照试验来研究此问题。PROSPERO识别号：CRD42022334959. ©2023. 亚洲妇科肿瘤学会、韩国妇科肿瘤学会和日本妇科肿瘤学会。

Neoadjuvant chemotherapy (NACT) represents a treatment option in patients with advanced epithelial ovarian cancer (AEOC) who are not good candidates for primary debulking surgery. Usually, 3 cycles of chemotherapy before surgery have been considered the best option for patient survival, although quite often some patients receive more than 3 cycles. The aim of this systematic review and meta-analysis was to identify the optimal number of NACT cycles reporting better survival in AEOC patients.PubMed, Cochrane Library, and Scopus were searched for original articles that analyzed the relationship between the number of chemotherapy cycles and clinical outcomes in AEOC patients before interval debulking surgery (IDS). The main outcomes were progression-free survival (PFS) and overall survival (OS).A total of 22 studies comprising 7,005 patients diagnosed with AEOC were included in our analysis. In terms of survival, the reviewed studies dividing the patients in ≤3 NACT cycles vs. >3, showed a trend for a decrease in PFS and a significant reduction in OS with an increasing number of cycles, while a difference in both PFS and OS was revealed if early IDS included patients with 4 NACT cycles. These results should be interpreted with caution due to the complex characteristics of AEOC patients.In conclusion, our review and meta-analysis revealed that there is not enough evidence to determine the optimal number of NACT treatments before surgery. Further research in the form of well-designed randomized controlled trials is necessary to address this issue.PROSPERO Identifier: CRD42022334959.© 2023. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology, and Japan Society of Gynecologic Oncology.