Ireland East Hospital Gynaeoncology Group, Mater Misericordiae University, Dublin 7, Ireland.
Dept of Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland.
Gynecol Oncol. 2019 Sep;154(3):622-630. doi: 10.1016/j.ygyno.2019.07.011. Epub 2019 Jul 23.
Aim The aim of this meta-analysis is to review the morbidity and mortality associated with primary cytoreductive surgery (PCS) compared to neoadjuvant chemotherapy and interval cytoreductive surgery (NACT + ICS) for advanced ovarian cancer.
A literature search was performed for publications reporting morbidity and mortality in patients undergoing PCS compared to NACT + ICS. Databases searched were Cochrane, Medline, Pubmed, Pubmed Central, clinicaltrials.gov and Embase. Two independent reviewers applied inclusion and exclusion criteria to select included papers, with differences agreed by consensus. A total of 1341 citations were reviewed; 17 studies comprising 3759 patients were selected for the analysis. The literature search was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results were reported as mean differences or pooled odds ratios (OR) with 95% confidence intervals (95% CI).
Patients in the PCS group were significantly more likely to have a Clavien-Dindo grade ≥ 3 morbidity with an overall rate of 21.2% compared to 8.8% (95%CI 1.9-4.0, p < 0.0001) and were more likely to die within 30 days of surgery (OR 6.1, 95% CI 2.1-17.6, p = 0.0008). Patients who underwent NACT + ICS had significantly shorter procedural times (MD -35 min, p = 0.01), lost less blood intraoperatively (MD-382 ml, p < 0.001) and had an average admission 5.0 days shorter (MD -5.0 days, 95% CI -8.1 to -1.9 days, p = 0.002) than those undergoing PCS. While NACT was associated with significantly increased optimal and complete cytoreduction rates (OR 1.9, 95% CI 1.3-2.9, p = 0.001, and OR 2.2, 95% CI 1.5-3.3, p = 0.0001 respectively), this did not confer any additional survival benefit (OR 1.0, p = 0.76).
NACT is associated with less morbidity and mortality and improved complete cytoreduction compared to PCS, with no survival benefit. Hence NACT is an acceptable alternative in selected patients in particular with medical co-morbidities or a high tumour burden.
本荟萃分析旨在回顾原发性细胞减灭术（PCS）与新辅助化疗和间隔细胞减灭术（NACT+ICS）治疗晚期卵巢癌相关的发病率和死亡率。
对报告接受 PCS 与 NACT+ICS 治疗的患者发病率和死亡率的文献进行了检索。检索的数据库包括 Cochrane、Medline、Pubmed、Pubmed Central、clinicaltrials.gov 和 Embase。两名独立审查员应用纳入和排除标准选择纳入的论文，存在分歧的通过共识解决。共审查了 1341 条引文；有 17 项研究共纳入 3759 名患者进行分析。文献检索采用系统评价和荟萃分析的 Preferred Reporting Items（PRISMA）指南。结果以均数差异或合并优势比（OR）及 95%置信区间（95%CI）表示。
PCS 组患者发生 Clavien-Dindo 分级≥3 级发病率显著更高，总体发生率为 21.2%，而 NACT+ICS 组为 8.8%（95%CI 1.9-4.0，p<0.0001），且术后 30 天内死亡的可能性更高（OR 6.1，95%CI 2.1-17.6，p=0.0008）。接受 NACT+ICS 的患者手术时间明显缩短（MD-35 分钟，p=0.01），术中失血量明显减少（MD-382 毫升，p<0.001），住院时间平均缩短 5.0 天（MD-5.0 天，95%CI-8.1 至-1.9 天，p=0.002）。尽管 NACT 与更高的最佳和完全肿瘤细胞减灭率相关（OR 1.9，95%CI 1.3-2.9，p=0.001 和 OR 2.2，95%CI 1.5-3.3，p=0.0001），但这并未带来任何生存获益（OR 1.0，p=0.76）。
与 PCS 相比，NACT 可降低发病率和死亡率，并提高完全肿瘤细胞减灭率，但不能带来生存获益。因此，在特定患者，特别是有合并症或肿瘤负荷较高的患者中，NACT 是一种可接受的替代方案。
