Campbell S, Gentry-Maharaj A
a Create Fertility , London , UK.
b Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health , University College London , London , UK.
Climacteric. 2018 Jun;21(3):221-226. doi: 10.1080/13697137.2018.1433656. Epub 2018 Mar 1.
Ovarian cancer is a low-prevalence postmenopausal cancer with a high mortality rate and is the fifth most lethal cancer in women. The most common serous subtype with TP53 mutations spreads rapidly throughout the peritoneal cavity (stage III/IV) when 5-year survival is 10%. If diagnosed while confined to the ovary (stage I), the survival rate exceeds 90%. This is the rationale for screening. Annual transvaginal ultrasound (TVU) scans used as a primary screening modality or as a second-line test following primary screening with serum CA125 (multimodal) have been investigated in several trials. Only two large randomized controlled trials have provided mortality data. The US Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial studied over 78 000 women (randomized to screening with either TVU or CA125, or control) over 6 years with 14 years follow-up and found no mortality benefit from screening and increased morbidity in the screened arm. The UK Collaborative Trial of Ovarian Cancer Screening studied over 202 000 women randomized to TVU, multimodal or control in a 1 : 1 : 2 ratio over 7-11 years with 11 years follow-up. CA125 was interpreted by the Risk of Ovarian Cancer algorithm which identifies a rise in the level rather than a fixed cut-off. There was a late reduction in mortality after 7 years in the screened arm (23% in the multimodal arm and 21% in the TVU arm), but the overall reduction was not significant. Further follow-up may reveal whether TVU has a primary or secondary role in ovarian cancer screening.
卵巢癌是一种绝经后发病率较低但死亡率较高的癌症，是女性中致死率排名第五的癌症。最常见的具有TP53突变的浆液性亚型在5年生存率为10%时会迅速扩散至整个腹腔（III/IV期）。如果在局限于卵巢时被诊断出来（I期），生存率超过90%。这就是筛查的理论依据。在多项试验中研究了将年度经阴道超声（TVU）扫描用作主要筛查方式或作为血清CA125（多模式）初筛后的二线检测方法。只有两项大型随机对照试验提供了死亡率数据。美国前列腺、肺癌、结直肠癌和卵巢癌筛查试验对超过78000名女性进行了6年研究（随机分为接受TVU或CA125筛查或对照），并进行了14年随访，发现筛查没有带来死亡率益处，且筛查组的发病率增加。英国卵巢癌筛查协作试验对超过202000名女性进行了研究，她们以1∶1∶2的比例随机分为TVU组、多模式组或对照组，研究时间为7至11年，随访11年。CA125由卵巢癌风险算法进行解读，该算法识别的是水平升高而非固定阈值。筛查组在7年后死亡率出现了后期下降（多模式组为23%，TVU组为21%），但总体下降并不显著。进一步随访可能会揭示TVU在卵巢癌筛查中是起主要作用还是次要作用。
