1Department of Neurosurgery and.
2Sylvester Comprehensive Cancer Center, University of Miami, Florida.
Neurosurg Focus. 2023 Aug;55(2):E12. doi: 10.3171/2023.5.FOCUS23115.
Ovarian cancer is a rare origin of brain metastasis (BM), with an incidence of only 1%-3%. Consequently, the literature is sparse, and no treatment consensus guideline is available for ovarian BM. The authors conducted a systematic review of ovarian BM and performed a combined pooled cohort survival analysis with their case series.
A systematic review of PubMed, Scopus, and Web of Science consistent with PRISMA guidelines along with an institutional retrospective chart review was conducted. Inclusion criteria for the systematic review included patients with confirmed BM and primary ovarian cancer, reported perioperative complications and outcomes, differentiated histology, and explicitly reported individual patient data. Reviews, commentaries, technical notes, and articles without English-language translations were excluded. The Newcastle-Ottawa Quality Assessment Scale was used independently by the first and second authors to assess the quality of each article. The authors performed univariate and multivariate analyses of several survival prognostic factors. Kaplan-Meier curves were generated for significant prognostic factors in the univariate analysis.
A total of 48 patients with individual data across 34 studies and 8 patients from the authors' institution were included. All patients (n = 56) underwent resection for BM; 83.9% received adjuvant radiotherapy following surgery and 41.1% of patients received adjuvant chemotherapy. The median progression-free survival was 12 months (range 2-43 months). The median overall survival was 9 months (range 1-49 months). On univariate analysis, a single BM and no extracranial metastasis conferred a survival benefit, while clear cell carcinoma as the primary histology corresponded to worsened OS. Multivariable analysis showed that age > 50 years (p = 0.002) and > 1 BM (p < 0.001) were risk factors for poor prognosis. Protective factors included the addition of the following multimodal adjuvant therapy with surgery: radiotherapy (p = 0.002), chemotherapy and radiotherapy (p = 0.005), and stereotactic radiosurgery (p = 0.002).
Although the scarcity of published individual patient data hinders the determination of optimal management, the authors' analysis highlights that multimodal therapies, a single cranial lesion, and age < 50 years are associated with increased survival for patients with ovarian BMs.
卵巢癌是脑转移（BM）的罕见来源，发病率仅为 1%-3%。因此，相关文献较少，尚无针对卵巢 BM 的治疗共识指南。作者对卵巢 BM 进行了系统评价，并对其病例系列进行了联合汇总队列生存分析。
按照 PRISMA 指南对 PubMed、Scopus 和 Web of Science 进行了系统评价，并进行了机构回顾性图表审查。系统评价的纳入标准包括确诊为 BM 和原发性卵巢癌的患者、报告围手术期并发症和结局、分化组织学以及明确报告个体患者数据的研究。排除了评论、评论、技术说明和没有英文翻译的文章。第一和第二作者独立使用纽卡斯尔-渥太华质量评估量表评估每篇文章的质量。作者对几个生存预后因素进行了单变量和多变量分析。对单变量分析中具有显著预后意义的因素进行 Kaplan-Meier 曲线分析。
共纳入 34 项研究的 48 名患者和作者所在机构的 8 名患者的个体数据。所有患者（n=56）均行 BM 切除术；术后 83.9%接受辅助放疗，41.1%的患者接受辅助化疗。无进展生存期的中位数为 12 个月（范围 2-43 个月）。总生存期的中位数为 9 个月（范围 1-49 个月）。单变量分析显示，单发 BM 和无颅外转移与生存获益相关，而原发性组织学为透明细胞癌则与 OS 恶化相关。多变量分析显示，年龄＞50 岁（p=0.002）和＞1 个 BM（p＜0.001）是预后不良的危险因素。保护因素包括在手术基础上增加以下多模态辅助治疗：放疗（p=0.002）、化疗联合放疗（p=0.005）和立体定向放射外科手术（p=0.002）。
尽管发表的个体患者数据较少，限制了最佳治疗方案的确定，但作者的分析强调，多模态治疗、单发颅内病变和年龄＜50 岁与卵巢 BM 患者的生存增加相关。
