Bristow R E, Lagasse L D, Karlan B Y
Department of Obstetrics and Gynecology, UCLA School of Medicine, USA.
Cancer. 1996 Nov 15;78(10):2049-62.
Standard therapy for advanced epithelial ovarian cancer now includes primary cytoreductive surgery followed by combination chemotherapy. Optimal primary debulking is associated with improved clinical response rates to primary chemotherapy as well as longer overall survival. The benefits of secondary cytoreductive surgery for persistent or recurrent ovarian cancer have not been as clearly established as those of primary surgery.
The English language literature was searched, using a MEDLINE database, to identify all clinical investigations pertaining to secondary cytoreductive surgery for epithelial ovarian cancer. Additional sources were found in reference lists from original research and review articles. Particular emphasis was placed on those studies allowing secondary operations for ovarian cancer to be grouped into four clinical scenarios: (1) recurrent disease, (2) second-look laparotomy (SLL), (3) interval cytoreduction, and (4) progressive disease.
Patients with recurrent disease, particularly after a prolonged disease free interval, may derive a significant survival benefit from optimal debulking. The available data also indicate that patients whose disease is in complete clinical remission, with macroscopic disease detected at the time of SLL, benefit from cytoreduction to microscopic disease residual. Cytoreduction that leaves SLL patients with a small amount of macroscopic disease may provide some survival benefit, but the degree of that benefit is unclear. Patients who undergo suboptimal primary debulking and later demonstrate a favorable response to induction chemotherapy may derive a modest survival advantage from an optimal interval cytoreductive procedure.
Proper selection of patients with recurrent or initially suboptimally resected ovarian cancer is essential to maximize the potential therapeutic benefit of secondary cytoreductive surgery.
晚期上皮性卵巢癌的标准治疗目前包括初次肿瘤细胞减灭术，随后进行联合化疗。最佳的初次肿瘤减灭术与对初次化疗更高的临床缓解率以及更长的总生存期相关。对于持续性或复发性卵巢癌进行二次肿瘤细胞减灭术的益处，尚未像初次手术那样得到明确证实。
利用MEDLINE数据库检索英文文献，以识别所有与上皮性卵巢癌二次肿瘤细胞减灭术相关的临床研究。在原始研究和综述文章的参考文献列表中找到了其他来源。特别强调那些允许将卵巢癌二次手术分为四种临床情况的研究：（1）复发性疾病，（2）二次探查剖腹术（SLL），（3）中间期肿瘤细胞减灭术，以及（4）疾病进展。
复发性疾病患者，尤其是在较长的无病间期后，可能从最佳肿瘤减灭术中获得显著的生存益处。现有数据还表明，疾病处于临床完全缓解、在二次探查剖腹术时检测到有肉眼可见疾病的患者，从肿瘤细胞减灭至残留微小疾病中获益。二次探查剖腹术患者残留少量肉眼可见疾病时进行肿瘤细胞减灭术可能会带来一些生存益处，但这种益处的程度尚不清楚。初次肿瘤减灭术不理想且随后对诱导化疗表现出良好反应的患者，可能从最佳的中间期肿瘤细胞减灭术中获得适度的生存优势。
正确选择复发性或初次手术切除不理想的卵巢癌患者，对于最大化二次肿瘤细胞减灭术的潜在治疗益处至关重要。
