Conte Carmine, Fagotti Anna, Avesani Giacomo, Trombadori Charlotte, Federico Alex, D'Indinosante Marco, Giudice Maria Teresa, Pelligra Silvia, Lodoli Claudio, Marchetti Claudia, Ferrandina Gabriella, Scambia Giovanni, Gallotta Valerio
Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy.
Ann Transl Med. 2021 Mar;9(6):510. doi: 10.21037/atm-20-4690.
The ovarian cancer recurrence occurs in 75% of patients with advanced FIGO stage, and its treatment is a challenge for the oncologist in gynecology. The standard treatment of recurrent ovarian cancer (ROC) usually includes intravenous chemotherapy according to platinum sensitivity. Furthermore, maintenance treatment with target therapies [e.g., anti-angiogenic drug or PARP inhibitors (PARPi)], should be provided if not precedently administrated. In this scenario, secondary cytoreductive surgery (SCS) remains a practical but controversial option for platinum-sensitive ROC (PSROC). So far, several retrospective series and a Cochrane meta-analysis had concluded that SCS could determine better survival outcomes in ROC with favorable prognostic characteristics, such as the presence of a single anatomical site of recurrence, or when patients are accurately selected for surgery based on complete resection's predictive models. Recently, three randomized clinical trials (RCTs) investigated the role of SCS in PSROC patients selected with different criteria. All the three RCTs showed a significant statistical advantage in progression-free survival (PFS) in the SCS group, with an even more significant difference in patients with complete cytoreduction (about 7-month PFS increased). Data on overall survival (OS) are different in the two completed trials. The GOG213 study has documented a longer OS of PSROC patients who received chemotherapy alone compared to surgery plus chemotherapy. Contrarily, the DESKTOP III trial showed 7.7 months of increased OS in the surgery group chemotherapy alone, with a more difference in the complete tumor cytoreduction (CTC) group (12 months). These RCTs thereby suggest that undergoing complete cytoreduction may not be the only key and that the disease biology may also matter. Few recent retrospective series investigated the role of SCS according to BRCA mutation status and the effect of SCS in patients receiving emerging PARPi. A consequence of the developments in SCS and knowledge of different molecular pathways influencing the recurrent disease is that the future research objective should be to individualize and personalize the surgical approach.
75%的国际妇产科联盟（FIGO）晚期患者会出现卵巢癌复发，其治疗对妇科肿瘤学家而言是一项挑战。复发性卵巢癌（ROC）的标准治疗通常包括根据铂敏感性进行静脉化疗。此外，如果之前未进行过靶向治疗，应采用靶向治疗进行维持治疗[例如，抗血管生成药物或聚（ADP - 核糖）聚合酶抑制剂（PARPi）]。在这种情况下，二次减瘤手术（SCS）对于铂敏感复发性卵巢癌（PSROC）仍然是一种可行但存在争议的选择。到目前为止，多项回顾性系列研究和一项Cochrane荟萃分析得出结论，对于具有良好预后特征的ROC患者，如存在单一解剖部位复发，或基于完全切除预测模型准确选择手术患者时，SCS可带来更好的生存结果。最近，三项随机临床试验（RCT）研究了SCS在采用不同标准选择的PSROC患者中的作用。所有这三项RCT均显示SCS组在无进展生存期（PFS）方面具有显著的统计学优势，在完全减瘤的患者中差异更为显著（PFS增加约7个月）。两项已完成试验的总生存期（OS）数据有所不同。妇科肿瘤学组（GOG）-213研究记录显示，与手术加化疗相比，单纯接受化疗的PSROC患者的OS更长。相反，DESKTOP III试验显示手术组的OS比单纯化疗组增加了7.7个月，在完全肿瘤减瘤（CTC）组差异更大（12个月）。因此，这些RCT表明，实现完全减瘤可能不是唯一的关键，疾病生物学因素可能也很重要。最近很少有回顾性系列研究根据BRCA突变状态研究SCS的作用以及SCS在接受新型PARPi治疗患者中的效果。SCS的发展以及对影响复发性疾病的不同分子途径的认识所带来的一个结果是，未来的研究目标应该是使手术方法个体化和个性化。
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