Impact of Hormone Replacement Therapy on the Overall Survival and Progression Free Survival of Ovarian Cancer Patients: A Systematic Review and Meta-Analysis

SIMPLE SUMMARY: The standard treatment course for ovarian cancer virtually always induces menopause with subsequent symptoms. This systematic review and meta-analysis strived to further elucidate the safety of Hormone Replacement Therapy in the setting of ovarian cancer treatments by investigating its effect on Overall Survival and Progression-Free Survival. The results highlighted a slight benefit in terms of survival and recurrence rates in favour of the hormone replacement therapy groups, pooling respective Hazard Ratios (HR) of 0.66 and 0.73. However, detailed subgroup analyses revealed no statistically significant results in terms of recurrence for the treated groups, while data were sequenced based on stages, grade of differentiation, the radicality of surgery, and the age of participants. Even so, in null outcomes regarding progression-free survival, hormone replacement therapy remains advantageous in lessening menopausal symptoms and improving the quality of life for these patients. ABSTRACT: Background: Frequently, patients treated for Ovarian Cancer (OC) undergo menopause with subsequent symptoms. This review scrutinised the impact of Hormone Replacement Therapy (HRT) on the Overall Survival (OS) and Progression-Free Survival (PFS) of patients diagnosed with OC. Methods: A systematic literature search was conducted in the most popular English databases. Inclusion and exclusion criteria were applied to select publications that evaluate OS and PFS in these patients. End-point analysis targeted values of log(HR) and its Standard Error (SE). Results: Up to 1 September 2022, 11 studies were included in the qualitative synthesis. Eight publications, totalling 4191 patients, were included in the meta-analyses. Eight studies were considered for the OS analysis and pooled an HR of 0.66 with respective 95% CI between 0.57 and 0.76, with a p-value < 0.00001 at a Z value of 5.7, in favour of the HRT group. Results for PFS showed an overall HR of 0.73 in favour of the HRT group; CI between 0.57 and 0.95, p = 0.02 at a Z value of 2.36. Further subgroup analyses highlighted the non-inferiority of this treatment. Conclusions: Patients treated for OC that receive HRT for menopausal symptoms after various treatments appeared to have better OS than never-users.