Ang Christine, Chan Karen K L, Bryant Andrew, Naik Raj, Dickinson Heather O
Gynaecological Oncology, Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, Tyne and Wear, UK, NE9 6SX.
Cochrane Database Syst Rev. 2011 Apr 13(4):CD007697. doi: 10.1002/14651858.CD007697.pub2.
Ovarian cancer is the sixth most common cancer among women and the leading cause of death in women with gynaecological malignancies. Opinions differ regarding the role of ultra-radical (extensive) cytoreductive surgery in ovarian cancer treatment.
To evaluate the effectiveness and morbidity associated with ultra-radical/extensive surgery in the management of advanced stage ovarian cancer.
We searched the Cochrane Gynaecological Cancer Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 4), MEDLINE and EMBASE (up to November 2010). We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field.
Randomised controlled trials (RCTs) or non-randomised studies, analysed using multivariate methods, that compared ultra-radical/extensive and standard surgery in adult women with advanced primary epithelial ovarian cancer.
Two review authors independently assessed whether potentially relevant studies met the inclusion criteria, abstracted data and assessed the risk of bias. One non-randomised study was identified so no meta-analyses were performed.
One non-randomised study met our inclusion criteria. It analysed retrospective data for 194 women with stage IIIC advanced epithelial ovarian cancer who underwent either ultra-radical (extensive) or standard surgery and reported disease specific overall survival and perioperative mortality. Multivariate analysis, adjusted for prognostic factors, identified better disease specific survival among women receiving ultra-radical surgery, although this was not statistically significant (Hazard ratio (HR) = 0.64, 95% confidence interval (CI): 0.40 to 1.04). In a subset of 144 women with carcinomatosis, those who underwent ultra-radical surgery had significantly better disease specific survival than women who underwent standard surgery (adjusted HR = 0.64, 95% CI 0.41 to 0.98). Progression-free survival and quality of life (QoL) were not reported and adverse events were incompletely documented. The study was at high risk of bias.
AUTHORS' CONCLUSIONS: We found only low quality evidence comparing ultra-radical and standard surgery in women with advanced ovarian cancer and carcinomatosis. The evidence suggested that ultra-radical surgery may result in better survival. It was unclear whether there were any differences in progression-free survival, QoL and morbidity between the two groups. The cost-effectiveness of this intervention has not been investigated. We are, therefore, unable to reach definite conclusions about the relative benefits and adverse effects of the two types of surgery.In order to determine the role of ultra-radical surgery in the management of advanced stage ovarian cancer, a sufficiently powered randomised controlled trial comparing ultra-radical and standard surgery or well-designed non-randomised studies would be required.
卵巢癌是女性中第六大常见癌症，也是妇科恶性肿瘤女性死亡的主要原因。关于超根治性（广泛性）细胞减灭术在卵巢癌治疗中的作用，观点存在分歧。
评估超根治性/广泛性手术治疗晚期卵巢癌的有效性及发病率。
我们检索了Cochrane妇科癌症组试验注册库、Cochrane对照试验中心注册库（CENTRAL）（《Cochrane图书馆》2010年第4期）、MEDLINE和EMBASE（截至2010年11月）。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，并联系了该领域的专家。
采用多变量方法分析的随机对照试验（RCT）或非随机研究，比较超根治性/广泛性手术与标准手术在成年晚期原发性上皮性卵巢癌女性中的疗效。
两位综述作者独立评估潜在相关研究是否符合纳入标准，提取数据并评估偏倚风险。仅识别出一项非随机研究，因此未进行荟萃分析。
一项非随机研究符合我们的纳入标准。该研究分析了194例IIIC期晚期上皮性卵巢癌女性的回顾性数据，这些女性接受了超根治性（广泛性）手术或标准手术，并报告了疾病特异性总生存期和围手术期死亡率。经预后因素调整的多变量分析显示，接受超根治性手术的女性疾病特异性生存率更高，尽管差异无统计学意义（风险比（HR）=0.64，95%置信区间（CI）：0.40至1.04）。在144例有癌性腹膜炎的女性亚组中，接受超根治性手术的女性疾病特异性生存率显著高于接受标准手术的女性（调整后HR = 0.64，95%CI 0.41至0.98）。未报告无进展生存期和生活质量（QoL），不良事件记录不完整。该研究存在高度偏倚风险。
我们仅发现低质量证据比较晚期卵巢癌和癌性腹膜炎女性的超根治性手术与标准手术。证据表明超根治性手术可能带来更好的生存率。两组在无进展生存期、生活质量和发病率方面是否存在差异尚不清楚。该干预措施的成本效益尚未研究。因此，我们无法就两种手术的相对益处和不良反应得出明确结论。为了确定超根治性手术在晚期卵巢癌治疗中的作用，需要进行一项足够有力的随机对照试验，比较超根治性手术与标准手术，或设计良好的非随机研究。
