Han Ling, Chen Yali, Liu Yana, Zheng Ai, Chen Hengxi
Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University No. 20, 3rd Section, South Renmin Road, Chengdu 610041, Sichuan, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu 610041, Sichuan, China.
Am J Cancer Res. 2022 Sep 15;12(9):4458-4467. eCollection 2022.
Malignant ovarian germ cell tumors (MOGCTs) are predominately diagnosed in young patients and account for most preadolescent malignant ovarian tumors. Currently, due to the high sensitivity of MOGCTs to chemotherapy and the optimal survival rate after chemotherapy, some researchers have recommended opting for non-surgical treatment. However, the effect of lymphadenectomy (LND) on the survival of patients with MOGCT remains controversial. We conducted a systematic review and meta-analysis to compare the clinical outcomes of LND and non-LND in MOGCT surgeries in order to summarize the clinical experience. PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), International Clinical Trials Registry Platform (ICTRP), and Clinical Trials.gov were searched from inception to December 26, 2021. Data on the rates of survival, relapse, and adverse effects were evaluated using Review Manager software. Fourteen studies with 10,759 participants were included in this review. There were 5863 and 4896 patients in the LND- and LND+ groups, respectively. Pooled results showed that although disease-free survival (DFS) was significantly improved in the LND+ group compared to the LND- group (HR: 0.74; 95% CI: 0.56 to 0.97; 2091 participants), LND did not significantly affect overall survival (OS) (HR: 0.82; 95% CI: 0.51 to 1.31; 5298 participants). The operation time was significantly longer in the LND+ group than in the LND- group (P<0.001). Blood loss (P=0.004) and complication rate (P=0.003) were also significantly higher in the LND+ group than in the LND- group. There was no significant difference in mortality rate (P=0.500). LND was associated with an improvement in DFS. However, there was no significant difference in OS in MOGCTs. We recommend that LND should not be a routine surgery for children or young patients with MOGCTs; although it may be beneficial for older people, advanced stage tumors, specific pathological types, and non-chemotherapy patients.
恶性卵巢生殖细胞肿瘤（MOGCTs）主要在年轻患者中被诊断出来，占青春期前大多数恶性卵巢肿瘤。目前，由于MOGCTs对化疗高度敏感且化疗后生存率理想，一些研究人员建议选择非手术治疗。然而，淋巴结切除术（LND）对MOGCT患者生存的影响仍存在争议。我们进行了一项系统评价和荟萃分析，以比较MOGCT手术中LND和非LND的临床结果，从而总结临床经验。检索了PubMed、Embase、Web of Science、Cochrane对照试验中心注册库（CENTRAL）、国际临床试验注册平台（ICTRP）和ClinicalTrials.gov，检索时间从创建到2021年12月26日。使用Review Manager软件评估生存、复发和不良反应发生率的数据。本评价纳入了14项研究，共10759名参与者。LND组和LND+组分别有5863例和4896例患者。汇总结果显示，虽然LND+组与LND组相比无病生存期（DFS）显著改善（HR：0.74；95%CI：0.56至0.97；2091名参与者），但LND对总生存期（OS）无显著影响（HR：0.82；95%CI：0.51至1.31；5298名参与者）。LND+组的手术时间显著长于LND组（P<0.001）。LND+组的失血量（P=0.004）和并发症发生率（P=0.003）也显著高于LND组。死亡率无显著差异（P=0.500）。LND与DFS的改善相关。然而，MOGCTs患者的OS无显著差异。我们建议，对于患有MOGCTs的儿童或年轻患者，LND不应作为常规手术；尽管它可能对老年人、晚期肿瘤、特定病理类型和非化疗患者有益。
