Fumagalli Diletta, Jayraj Aarthi, Olearo Elena, Capasso Ilaria, Hsu Heng-Cheng, Tzur Yossi, Piedimonte Sabrina, Jugeli Bella, Santana Beatriz Navarro, De Vitis Luigi Antonio, Caruso Giuseppe, Aletti Giovanni, Colombo Nicoletta, Ramirez Pedro T
European Institute of Oncology, Department of Gynecology, Division of Gynecologic Surgery, Milan, Italy; Mayo Clinic, Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Rochester, MN, USA.
All India Institute of Medical Sciences, Department of Obstetrics and Gynecology, New Delhi, India.
Int J Gynecol Cancer. 2025 Mar;35(3):101664. doi: 10.1016/j.ijgc.2025.101664. Epub 2025 Jan 28.
The standard treatment for advanced epithelial ovarian cancer is primary cytoreductive surgery, with the goal of achieving no residual disease. Neoadjuvant chemotherapy and interval cytoreductive surgery can be viable treatment options for patients with extensive disease that precludes complete tumor removal during initial surgery, or when significant comorbidities increase the surgical risk without adversely impacting overall survival rates. However, published studies mostly included patients with high-grade serous ovarian cancer, with an underrepresentation of non-high-grade serous epithelial and non-epithelial cancers. This review aimed to provide an overview of the available data on the outcomes of primary cytoreductive surgery versus interval cytoreduction in patients with rare ovarian cancer histotypes.
Published literature on primary versus interval cytoreductive surgery in non-high-grade serous ovarian cancers from 2004 to 2024 was searched using PubMed, EMBASE, and Google Scholar and reported for each histological subtype. The outcomes of patients with low-grade serous, endometrioid, clear-cell, and mucinous carcinomas after neoadjuvant chemotherapy were reviewed. Furthermore, the results following neoadjuvant chemotherapy in non-epithelial ovarian cancers, such as ovarian germ cell tumors, sex cord-stromal tumors, and small-cell carcinoma of the ovary, have also been reported. Most data were derived from retrospective studies, with heterogeneity in design.
RESULTS & CONCLUSIONS: Several ovarian cancer histotypes, including low-grade serous and mucinous carcinomas, may be less responsive than high-grade serous carcinomas to neoadjuvant chemotherapy. Consequently, primary cytoreduction with maximal surgical effort may confer a survival advantage. Other tumors responded well to neoadjuvant chemotherapy, allowing for interval fertility-sparing surgeries. Additional evidence is required because no prospective studies are currently available. Given the low incidence of these diseases, randomized controlled trials may not be feasible. However, national or international registries could play a pivotal role in determining the optimal approach for managing patients with these rare histotypes.
晚期上皮性卵巢癌的标准治疗方法是初次肿瘤细胞减灭术，目标是实现无残留病灶。对于疾病广泛以至于初次手术无法完全切除肿瘤，或存在严重合并症导致手术风险增加但不影响总体生存率的患者，新辅助化疗和中间性肿瘤细胞减灭术是可行的治疗选择。然而，已发表的研究大多纳入了高级别浆液性卵巢癌患者，非高级别浆液性上皮癌和非上皮性癌的代表性不足。本综述旨在概述罕见卵巢癌组织学类型患者初次肿瘤细胞减灭术与中间性肿瘤细胞减灭术结局的现有数据。
使用PubMed、EMBASE和谷歌学术搜索2004年至2024年关于非高级别浆液性卵巢癌初次与中间性肿瘤细胞减灭术的已发表文献，并针对每种组织学亚型进行报告。回顾了低级别浆液性癌、子宫内膜样癌、透明细胞癌和黏液性癌患者新辅助化疗后的结局。此外，还报告了非上皮性卵巢癌（如卵巢生殖细胞肿瘤、性索间质肿瘤和卵巢小细胞癌）新辅助化疗后的结果。大多数数据来自回顾性研究，设计存在异质性。
包括低级别浆液性癌和黏液性癌在内的几种卵巢癌组织学类型，可能比高级别浆液性癌对新辅助化疗的反应性更低。因此，尽最大手术努力进行初次肿瘤细胞减灭术可能具有生存优势。其他肿瘤对新辅助化疗反应良好，可进行保留生育功能的中间性手术。由于目前尚无前瞻性研究，需要更多证据。鉴于这些疾病的发病率较低，随机对照试验可能不可行。然而，国家或国际登记处可能在确定这些罕见组织学类型患者的最佳管理方法方面发挥关键作用。
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