Kim Ji Hyun, Kim Se Ik, Park Eun Young, Ha Hyeong In, Kim Jae-Weon, Coleman Robert L, Bristow Robert E, Park Sang-Yoon, Fotopoulou Christina, Lim Myong Cheol
Center for Gynecologic Cancer, National Cancer Center, Goyang, Republic of Korea.
Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.
Gynecol Oncol. 2023 Oct 27;179:24-32. doi: 10.1016/j.ygyno.2023.10.018.
Current treatment strategies for primary epithelial ovarian cancer (EOC) have significantly evolved, and the value of complete cytoreduction has not yet been reassessed. The study aimed to investigate the impact of residual disease after cytoreductive surgery for EOC on survival outcomes within the recent paradigm of frontline ovarian cancer treatment.
We searched relevant literature from the MEDLINE, Embase, and Cochrane Library databases to identify randomized controlled trials and prospective clinical trials of primary EOC published between 1 January 2000 and 22 September 2022. To evaluate the impact of postoperative residual tumors on progression-free survival (PFS) and OS, we constructed a linear regression model for log-transformed median PFS and OS. Patients who did or did not receive first-line maintenance therapy were examined.
A total of 97 trials with 43,260 patients were included:2476 received poly(ADP-ribose) polymerase (PARP) inhibitors and 6587 received bevacizumab. Multivariable analysis of the linear regression model of all studies revealed that the median OS increased by 12.97% for every 10% increase in complete cytoreduction rates, independent of the use of systemic maintenance. In the subgroup analysis of patients receiving maintenance therapies, the effect of complete tumor clearance was potentiated, with a median OS increase of 19.13% for every 10% increase in complete cytoreduction rates.
Total macroscopic tumor clearance at the initial presentation of EOC significantly prolongs OS. Our results establish the importance of complete surgical cytoreduction, even after the introduction of recent advances in frontline treatment for EOC.
原发性上皮性卵巢癌（EOC）的当前治疗策略已显著演变，而完全细胞减灭术的价值尚未重新评估。本研究旨在探讨在一线卵巢癌治疗的最新模式下，EOC细胞减灭术后残留疾病对生存结局的影响。
我们检索了MEDLINE、Embase和Cochrane图书馆数据库中的相关文献，以识别2000年1月1日至2022年9月22日期间发表的原发性EOC的随机对照试验和前瞻性临床试验。为了评估术后残留肿瘤对无进展生存期（PFS）和总生存期（OS）的影响，我们构建了对数转换后的中位PFS和OS的线性回归模型。对接受或未接受一线维持治疗的患者进行了检查。
共纳入97项试验，涉及43260例患者：2476例接受聚（ADP - 核糖）聚合酶（PARP）抑制剂治疗，6587例接受贝伐单抗治疗。所有研究的线性回归模型多变量分析显示，完全细胞减灭率每增加10%，中位OS增加12.97%，与全身维持治疗的使用无关。在接受维持治疗的患者亚组分析中，完全肿瘤清除的效果增强，完全细胞减灭率每增加10%，中位OS增加19.13%。
EOC初次就诊时完全清除宏观肿瘤可显著延长OS。我们的结果确立了完全手术细胞减灭术的重要性，即使在EOC一线治疗取得最新进展之后。
