University of Cincinnati Medical Center, Cincinnati, Ohio.
US Oncology Network, The Woodlands, Texas.
Clin Adv Hematol Oncol. 2020 Jun;18(6):332-343.
Ovarian cancer causes more deaths than any other cancer of the female genital tract. Despite improvements in management and treatment, survival remains low in patients with extensive disease at presentation, which usually leads to eventual recurrence. Treatment of recurrence remains challenging. Although the use of secondary cytoreduction to treat recurrent disease has become widespread, its utility remains unproven.
This systematic review examines all the relevant electronic literature. An electronic literature search was conducted in the PubMed, MEDLINE, and EMBASE databases from January 1980 through December 2019.
Several relevant retrospective studies have been published, and these unanimously suggest that secondary cytoreduction is associated with an increase in progression-free and overall survival after relapse. Despite sound statistical methods, these studies are unfortunately limited by significant confounding inherent to the retrospective approach and by selection bias, given that healthier patients with less disease have historically been selected for surgery. Data from clinical trials are currently evolving. Early data from DESKTOP III demonstrate improved progression-free survival with secondary cytoreduction, whereas GOG-0213 found no difference in progression-free or overall survival.
Secondary cytoreduction remains a viable treatment option for select patients for now, but this is entirely dependent on the highly anticipated overall survival results of DESKTOP III and SOC 1.
卵巢癌导致的死亡人数超过女性生殖道任何其他癌症。尽管管理和治疗有所改善，但在就诊时广泛疾病的患者中，生存率仍然较低，这通常会导致最终复发。复发性疾病的治疗仍然具有挑战性。尽管二次细胞减灭术已广泛用于治疗复发性疾病，但其实用性仍未得到证实。
本系统评价检查了所有相关的电子文献。对 1980 年 1 月至 2019 年 12 月期间 PubMed、MEDLINE 和 EMBASE 数据库中的电子文献进行了检索。
已经发表了几项相关的回顾性研究，这些研究一致表明，二次细胞减灭术与复发后无进展生存期和总生存期的延长相关。尽管采用了可靠的统计方法，但这些研究不幸受到回顾性方法固有的严重混杂因素和选择偏倚的限制，因为历史上选择了疾病较少且更健康的患者进行手术。临床试验的数据目前正在不断发展。DESKTOP III 的早期数据表明，二次细胞减灭术可改善无进展生存期，而 GOG-0213 则发现无进展生存期或总生存期无差异。
目前，对于某些患者来说，二次细胞减灭术仍然是一种可行的治疗选择，但这完全取决于 DESKTOP III 和 SOC 1 的总体生存结果。
