新辅助化疗对比初始肿瘤细胞减灭术治疗Ⅲ-Ⅳ期卵巢癌的荟萃分析

Neoadjuvant chemotherapy verus primary debulking surgery in stage III-IV ovarian cancer:A Meta-analysis

目的:比较Ⅲ-Ⅳ期卵巢癌(International Federation of Gynecology and Obstetrics,FIGO)新辅助化疗(neoadjuvant chemotherapy,NACT)联合间隔减瘤手术与初始肿瘤细胞减灭术(primary debulking surgery,PDS)联合化疗两种治疗模式有效性及安全性差异。方法:计算机检索Pubmed、Cochrane Library、Embase、Web of Science、中国生物医学文献数据库、万方数据库和中国知网等数据库,查找NACT对比PDS治疗Ⅲ-Ⅳ期卵巢癌随机对照研究相关文献,应用Review Manager 5.3软件进行统计分析。结果:纳入4项研究,共计1631例患者。NACT组与PDS组总生存期(HR=0.95,95%CI为0.84~1.07,P=0.38)和无进展生存期相似(HR=0.97,95%CI为0.88~1.08,P=0.61);NACT组肿瘤完整切除率较PDS组提高(RR=2.47,95%CI为1.50~4.05,P=0.0004)。在不良反应和安全性方面,NACT组患者≥3级静脉血栓发生率(RR=0.25,95%CI为0.10~0.62,P=0.003)、≥3级感染发生率(RR=0.30,95%CI为0.16~0.56,P=0.0002)和围手术期死亡率(RR=0.17,95%CI为0.06~0.48,P=0.0009)均降低。结论:在Ⅲ-Ⅳ期卵巢癌治疗中,两种治疗模式生存获益相当,但新辅助化疗联合间隔减瘤手术可以提高肿瘤完整切除率,具有更好的安全性。新辅助化疗联合间隔减瘤手术可作为Ⅲ-Ⅳ期卵巢癌患者一种推荐治疗方式。

Objective:To compare the efficacy and safety of neoadjuvant chemotherapy followed by interval debulking surgery with primary debulking surgery followed by chemotherapy for stage III-IV ovarian cancer.Methods:A computerized search was performed in Pubmed,Cochrane Library,Embase,Web of Science,CBM,Wanfang Data and VIP,to collect controlled clinical trails of neoadjuvant chemotherapy followed by interval debulking surgery versus primary debulking surgery followed by chemotherapy in the treatment of stage III-IV ovarian cancer.RevMan 5.3 software was utilized for statistical analysis.Results:Four controlled clinical study involving 1631 women were included.There were no significant differences in overall survival(HR=0.95,95%CI 0.84~1.07,P=0.38)and progression-free survival(HR=0.97,95%CI 0.88~1.08,P=0.61)between neoadjuvant chemotherapy group and primary debulking surgery group.Neoadjuvant chemotherapy is associated with significantly higher rate of complete cytoreduction(RR=2.47,95%CI 1.50~4.05,P=0.0004),and fewer rate of grade≥3 venous thromboembolism(RR=0.25,95%CI 0.10~0.62,P=0.003),rate of grade≥3 infection(RR=0.30,95%CI 0.16~0.56,P=0.0002),perioperative mortality(RR=0.17,95%CI 0.06~0.48,P=0.0009).Conclusion:In the treatment of stage III-IV ovarian cancer,two treatment modalities shows similar survival benefit.Neoadjuvant chemotherapy followed by interval debulking surgery could improve the complete cytoreduction rate,decrease grade≥3 venous thromboembolism incidence,rate of grade≥3 infection and perioperative mortality.Neoadjuvant chemotherapy is an acceptable standard of care for women with stage III-IV ovarian cancer.