Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO, USA.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Denver, CO, USA
BMJ. 2020 Nov 9;371:m3773. doi: 10.1136/bmj.m3773.
Ovarian cancer is the third most common gynecologic malignancy worldwide but accounts for the highest mortality rate among these cancers. A stepwise approach to assessment, diagnosis, and treatment is vital to appropriate management of this disease process. An integrated approach with gynecologic oncologists as well as medical oncologists, pathologists, and radiologists is of paramount importance to improving outcomes. Surgical cytoreduction to R0 is the mainstay of treatment, followed by adjuvant chemotherapy. Genetic testing for gene mutations that affect treatment is the standard of care for all women with epithelial ovarian cancer. Nearly all women will have a recurrence, and the treatment of recurrent ovarian cancer continues to be nuanced and requires extensive review of up to date modalities that balance efficacy with the patient's quality of life. Maintenance therapy with poly ADP-ribose polymerase inhibitors, bevacizumab, and/or drugs targeting homologous recombination deficiency is becoming more widely used in the treatment of ovarian cancer, and the advancement of immunotherapy is further revolutionizing treatment targets.
卵巢癌是全球第三大常见妇科恶性肿瘤，但在这些癌症中死亡率最高。评估、诊断和治疗的逐步方法对于这种疾病过程的适当管理至关重要。与妇科肿瘤学家、肿瘤内科医生、病理学家和放射科医生相结合的综合方法对于改善结果至关重要。达到 R0 的手术细胞减灭术是治疗的主要方法，随后是辅助化疗。对影响治疗的基因突变进行基因检测是所有上皮性卵巢癌患者的标准护理。几乎所有女性都会复发，复发性卵巢癌的治疗仍然需要细致入微，并需要广泛审查最新的治疗方法，在疗效和患者生活质量之间取得平衡。聚 ADP-核糖聚合酶抑制剂、贝伐单抗和/或针对同源重组缺陷的药物的维持治疗在卵巢癌治疗中越来越广泛地应用，免疫疗法的进步正在进一步改变治疗靶点。
