van de Vorst R E W M, Huiskamp M D, Gort E H, Witteveen P O, Zweemer R P, Gerestein C G
Department of Gynecological Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
Department of Medical Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
Gynecol Oncol Rep. 2025 Jul 18;60:101809. doi: 10.1016/j.gore.2025.101809. eCollection 2025 Aug.
This systematic review aims to evaluate the added value of chemotherapy after secondary cytoreductive surgery (SCS) on survival in patients with unifocal and multifocal first recurrent epithelial ovarian cancer (EOC). Moreover, it compares survival outcomes between unifocal and multifocal recurrences in treatment outcomes.
A systematic search was conducted across PubMed, Embase, and the Cochrane Library identified 907 articles. Studies were selected if they involved patients with first recurrent EOC undergoing SCS, stratified by unifocal or multifocal recurrence. The primary outcomes were progression-free survival (PFS) and overall survival (OS).
No studies specifically addressed the added value of chemotherapy after SCS in unifocal versus multifocal first recurrent EOC. This systematic review identified eight studies examining PFS and OS in patients with unifocal and multifocal first recurrent EOC following SCS with chemotherapy. Findings consistently show that unifocal first recurrent EOC is associated with significantly improved PFS and OS compared to multifocal first recurrent EOC. However, the extent of the survival benefit varied. Six studies showed an advantage for unifocal recurrence on multivariate analyses, although two studies did not find statistically significant differences after adjusting for other variables.
This review shows that there is a knowledge gap regarding the added value of chemotherapy after complete SCS in first recurrent EOC. However, this review shows a survival advantage of unifocal over multifocal first recurrent EOC. There is a need for clinical trials to compare survival outcomes between unifocal and multifocal first recurrent EOC patients undergoing SCS alone or SCS with chemotherapy.
本系统评价旨在评估二次减瘤手术（SCS）后化疗对单灶性和多灶性首次复发上皮性卵巢癌（EOC）患者生存的附加价值。此外，还比较了单灶性和多灶性复发在治疗结果方面的生存结局。
在PubMed、Embase和Cochrane图书馆进行系统检索，共识别出907篇文章。纳入的研究需涉及接受SCS的首次复发EOC患者，并按单灶性或多灶性复发进行分层。主要结局为无进展生存期（PFS）和总生存期（OS）。
尚无研究专门探讨SCS后化疗在单灶性与多灶性首次复发EOC中的附加价值。本系统评价识别出八项研究，这些研究考察了接受SCS联合化疗的单灶性和多灶性首次复发EOC患者的PFS和OS。研究结果一致表明，与多灶性首次复发EOC相比，单灶性首次复发EOC的PFS和OS显著改善。然而，生存获益程度有所不同。六项研究在多因素分析中显示单灶性复发具有优势，尽管两项研究在调整其他变量后未发现统计学显著差异。
本评价表明，对于首次复发EOC患者在完成SCS后化疗的附加价值存在知识空白。然而，本评价显示单灶性首次复发EOC比多灶性具有生存优势。有必要开展临床试验，比较单独接受SCS或接受SCS联合化疗的单灶性和多灶性首次复发EOC患者的生存结局。
