Varghese Shriya, Lim Myong Cheol, Armbrust Robert, Pareja Rene, Fotopoulou Christina
Department of Surgery and Cancer, Imperial College London, London, UK.
Center for Gynecologic Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.
Int J Gynaecol Obstet. 2025 Sep;171 Suppl 1:129-137. doi: 10.1002/ijgo.70033. Epub 2025 Apr 25.
Ovarian cancer (OC) remains one of the most challenging gynecological malignancies to cure, despite recent advances in treatment. Disparities in the diagnosis, management, and survival of OC exist worldwide and addressing them remains an ongoing challenge. The highest burden of OC is projected to be in women living in low- and middle-income countries, where mortality rates are also disproportionately higher. Maximal effort cytoreduction paired with maximal effort systemic therapy followed by maintenance therapies remain the cornerstones of treatment for OC. Disparities are twofold: first, due to challenges with systemic therapy; and second, due to variations in surgical care, especially for advanced disease. While the goals of surgery remain unchanged, the radicality of cytoreductive resections and variation in practices worldwide have increased. The provision of surgical care for OC patients faces numerous challenges broadly categorized into three main areas: health system barriers; patient-related barriers; and physician-related barriers. Health system challenges include the lack of centralized cancer care, scarcity of resources, and inadequate funding. Patient-related obstacles include disparities in patient education, comorbidities, socioeconomic factors, and underrepresentation of certain ethnicities in clinical trials. Physician-related barriers encompass suboptimal surgical training, limited access to educational resources, inconsistent adherence to guidelines, limited use of a multidisciplinary team and overall differences in philosophy, ethos, and surgical tradition. Addressing and overcoming these barriers is essential to ensure equitable access to high-quality surgical care for OC patients worldwide. The aim of the present review was to further explore these global challenges while also highlighting potential strategies to reduce disparities in women's health care.
尽管近年来治疗方法有所进步，但卵巢癌（OC）仍然是最难治愈的妇科恶性肿瘤之一。OC在诊断、治疗和生存率方面存在全球差异，解决这些差异仍然是一项持续的挑战。预计OC负担最重的是生活在低收入和中等收入国家的女性，这些国家的死亡率也高得不成比例。最大限度的细胞减灭术与最大限度的全身治疗相结合，随后进行维持治疗，仍然是OC治疗的基石。差异有两方面：第一，由于全身治疗存在挑战；第二，由于手术治疗的差异，尤其是对于晚期疾病。虽然手术目标保持不变，但细胞减灭性切除术的激进程度以及全球范围内的实践差异有所增加。为OC患者提供手术治疗面临众多挑战，大致可分为三个主要领域：卫生系统障碍；患者相关障碍；以及医生相关障碍。卫生系统挑战包括缺乏集中的癌症护理、资源稀缺和资金不足。患者相关障碍包括患者教育方面的差异、合并症、社会经济因素以及某些种族在临床试验中的代表性不足。医生相关障碍包括手术培训不理想、获取教育资源有限、对指南的遵守不一致、多学科团队的使用有限以及总体在理念、风气和手术传统方面的差异。解决和克服这些障碍对于确保全球OC患者公平获得高质量手术治疗至关重要。本综述的目的是进一步探讨这些全球挑战，同时突出减少女性医疗保健差异的潜在策略。
