Faluyi Olusola, Mackean Melanie, Gourley Charlie, Bryant Andrew, Dickinson Heather O
Edinburgh Cancer Centre, Western General Hospital, Crewe Road, Edinburgh, Scotland, UK, EH4 2XU.
Cochrane Database Syst Rev. 2010 Sep 8;2010(9):CD007696. doi: 10.1002/14651858.CD007696.pub2.
The safety of conservative surgery and the benefit of additional interventions after surgery for borderline ovarian tumours are unknown.
To evaluate the benefits and harm of different treatment modalities offered for borderline ovarian tumours.
We searched the Cochrane Gynaecological Cancer Group Trials Register to 2009, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 4), MEDLINE and EMBASE to 2009. We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies.
Randomised controlled trials (RCTs) that compared different interventions in adult women diagnosed with borderline ovarian tumours of any histological variant.
Two review authors independently abstracted data and assessed risk of bias.
We identified seven RCTs that enrolled 372 women. We could not pool results of trials as the treatment comparisons differed.Six RCTs (n = 340) conducted over 15 years ago, evaluated adjuvant therapy (chemotherapy, pelvic external irradiation or intra-peritoneal radioactive isotope therapy) after radical surgery; over 87% of participants had Stage I tumours. Most participants were followed up for over 10 years. Overall and recurrence-free survival were similar between both arms of these trials, except that one trial (n = 66) showed a significantly lower survival (P = 0.03) in women who received chemotherapy (thio-TEPA). Adverse effects of treatment were incompletely reported and all six trials were at high risk of bias.One further trial (n = 32) that recruited participants with bilateral serous tumours who were wishing fertility preservation, revealed a significantly increased chance of pregnancy (hazard ratio (HR) = 3.3, 95% CI 1.4 to 8.0) but non-significantly earlier disease recurrence (HR = 1.5, 95% CI 0.6 to 3.8) in the women who had ultra-conservative surgery (bilateral cystectomy) than in those who had conservative surgery (cystectomy and contralateral oophorectomy). This trial was at low risk of bias.Quality of life (QoL) was not documented in any included trial. We did not find any trials that compared radical with conservative surgery or laparoscopy with laparotomy.
AUTHORS' CONCLUSIONS: We did not find evidence to support the use of any specific type of adjuvant therapy for borderline ovarian tumours. RCTs evaluating the benefit of adjuvant therapy with optimally dosed chemotherapy and newer targeted drugs are necessary, particularly for advanced borderline ovarian tumours. The low mortality from borderline ovarian tumours should make recurrence-free survival, time to recurrence and morbidity important end points in such trials.Bilateral cystectomy may be offered to women with bilateral borderline ovarian tumours diagnosed intra-operatively who are wishing to preserve their fertility. Similarly, women who had RCTs comparing radical with conservative surgery and comparing laparoscopy with laparotomy are needed.
交界性卵巢肿瘤保守性手术的安全性以及术后附加干预措施的益处尚不清楚。
评估为交界性卵巢肿瘤提供的不同治疗方式的益处和危害。
我们检索了截至2009年的Cochrane妇科癌症组试验注册库、Cochrane对照试验中央注册库（CENTRAL）（《Cochrane图书馆》2008年第4期）、截至2009年的MEDLINE和EMBASE。我们还检索了临床试验注册库、科学会议摘要、纳入研究的参考文献列表。
比较诊断为任何组织学类型的交界性卵巢肿瘤的成年女性不同干预措施的随机对照试验（RCT）。
两位综述作者独立提取数据并评估偏倚风险。
我们确定了7项RCT，纳入了372名女性。由于治疗比较不同，我们无法汇总试验结果。15年多以前进行的6项RCT（n = 340）评估了根治性手术后的辅助治疗（化疗、盆腔外照射或腹腔内放射性同位素治疗）；超过87%的参与者为Ⅰ期肿瘤。大多数参与者随访超过10年。这些试验的两组总体生存率和无复发生存率相似，但有一项试验（n = 66）显示接受化疗（噻替派）的女性生存率显著较低（P = 0.03）。治疗的不良反应报告不完整，所有6项试验均有较高的偏倚风险。另一项试验（n = 32）招募了希望保留生育能力的双侧浆液性肿瘤参与者，结果显示，与接受保守手术（囊肿切除术和对侧卵巢切除术）的女性相比，接受超保守手术（双侧囊肿切除术）的女性怀孕几率显著增加（风险比（HR） = 3.3，95%置信区间1.4至8.0），但疾病复发时间无显著差异（HR = 1.5，95%置信区间0.6至3.8）。该试验的偏倚风险较低。任何纳入试验均未记录生活质量（QoL）。我们未找到比较根治性手术与保守性手术或腹腔镜手术与开腹手术的试验。
我们未找到证据支持对交界性卵巢肿瘤使用任何特定类型的辅助治疗。有必要进行RCT评估最佳剂量化疗和新型靶向药物辅助治疗的益处，特别是对于晚期交界性卵巢肿瘤。交界性卵巢肿瘤的低死亡率应使无复发生存率、复发时间和发病率成为此类试验的重要终点。对于术中诊断为双侧交界性卵巢肿瘤且希望保留生育能力的女性，可提供双侧囊肿切除术。同样，需要进行RCT比较根治性手术与保守性手术以及腹腔镜手术与开腹手术。
