BackgroundPaclitaxel dose-dense regimen has been controversial in clinical trials in recent years. This systematic review and meta-analysis tried to evaluate the efficacy and safety of paclitaxel dose-dense chemotherapy in primary epithelial ovarian cancer.MethodsAn electronic search following PRISMA guidelines was conducted (Prospero registration number: CRD42020187622), and then a systematic review and meta-analysis of included literature were initiated to determine which regimen was better.ResultsFour randomized controlled trials were included in the qualitative evaluation, and 3699 ovarian cancer patients were included in the meta-analysis. The meta-analysis revealed that the dose-dense regimen could prolong PFS (HR0.88, 95%CI 0.81–0.96;p= 0.002) and OS (HR0.90, 95%CI 0.81–1.02;p= 0.09), but it also increased the overall toxicity (OR = 1.102, 95%CI 0.864–1.405;p= 0.433), especially toxicity of anemia (OR = 1.924, 95%CI 1.548–2.391;p< 0.001), neutropenia (OR = 2.372, 95%CI 1.674–3.361;p< 0.001). Subgroup analysis indicated that the dose-dense regimen could significantly prolong not only PFS (HR0.76, 95%CI 0.63–0.92;p= 0.005 VS HR0.91, 95%CI 0.83–1.00;p= 0.046) but also OS (HR0.75, 95%CI 0.557–0.98;p= 0.037 VS HR0.94, 95%CI 0.83–1.07;p= 0.371) in Asian, and overall toxicity was significantly increased in Asians (OR = 1.28, 95%CI: 0.877–1.858,p= 0.202) compared to non-Asians (OR = 1.02, 95%CI 0.737–1.396,p= 0.929).ConclusionPaclitaxel dose-dense regimen could prolong PFS and OS, but it also increased the overall toxicity. Therapeutic benefits and toxicity of dose-dense are more obvious in Asians compared to non-Asians, which need to be further confirmed in clinical trials.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13048-023-01216-z.