Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy.
Columbia University College of Physicians and Surgeons, New York, USA; New York Presbyterian Hospital, New York, USA.
Gynecol Oncol. 2022 Jul;166(1):181-187. doi: 10.1016/j.ygyno.2022.04.005. Epub 2022 May 9.
To evaluate the clinical utility of tertiary cytoreductive surgery (TCS) in recurrent ovarian cancer.
MEDLINE via PubMed, Embase (Elsevier), ClinicalTrials.gov, Scopus (Elsevier) and Web of Science for studies from inception to 4/09/2021. Studies reporting disease specific survival (DSS) and overall survival (OS) among women who underwent optimal cytoreductive surgery as compared to those who had a suboptimal cytoreductive surgery at time of TCS were abstracted. Study quality was assessed with the Quality In Prognosis Studies (QUIPS) tool. The data were extracted independently by multiple observers. Random-effects models were used to pool associations and to analyze the association between survival and surgical outcomes.
10 studies met all the criteria for inclusion in the systematic review. Patients with optimal tertiary cytoreductive surgery had better DSS (HR = 0.35; 95% CI, 0.19-0.64, P < 0.001), with low heterogeneity (I = 0%, P = 0.41) when compared to those with suboptimal tertiary cytoreductive surgery. Pooled results from these studies also demonstrated a better OS (HR = 0.34; 95% CI, 0.15-0.74, P < 0.007) with moderate heterogeneity (I = 59%, P = 0.09) when compared to patients with a suboptimal tertiary cytoreductive surgery. This remained significant in a series of sensitivity analyses. Due to the limited number of studies, we were unable to do further subgroup analyses looking at outcomes comparing tertiary cytoreductive surgery to chemotherapy.
In this systematic review and meta-analysis of observational studies examining tertiary cytoreductive surgery for recurrent ovarian cancer, optimal tertiary cytoreductive surgery was associated with improved OS and DSS survival compared to suboptimal tertiary cytoreductive surgery.
评估三级细胞减灭术（TCS）在复发性卵巢癌中的临床应用价值。
通过 MEDLINE（PubMed）、Embase（Elsevier）、ClinicalTrials.gov、Scopus（Elsevier）和 Web of Science 检索自创建至 2021 年 4 月 4 日的研究。提取比较最佳细胞减灭术与 TCS 时次优细胞减灭术患者疾病特异性生存率（DSS）和总生存率（OS）的研究。使用预后研究质量评估工具（QUIPS）评估研究质量。数据由多名观察者独立提取。采用随机效应模型对关联进行汇总分析，并分析生存与手术结果之间的关系。
10 项研究均符合系统评价的纳入标准。与次优 TCS 相比，行最优 TCS 的患者 DSS 更好（HR = 0.35；95%CI，0.19-0.64，P < 0.001），异质性低（I = 0%，P = 0.41）。这些研究的汇总结果还表明，与次优 TCS 相比，OS 更好（HR = 0.34；95%CI，0.15-0.74，P < 0.007），异质性中等（I = 59%，P = 0.09）。在一系列敏感性分析中，这一结果仍然显著。由于研究数量有限，我们无法进行进一步的亚组分析，以比较 TCS 与化疗的治疗效果。
在这项对复发性卵巢癌三级细胞减灭术的观察性研究的系统评价和荟萃分析中，与次优三级细胞减灭术相比，最佳三级细胞减灭术与改善的 OS 和 DSS 生存率相关。
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