Background/Objective: Platinum-resistant ovarian cancer (PROC) has limited therapeutic options, and the role of cytoreductive surgery (CRS) in improving survival outcomes remains uncertain. We performed a systematic review to evaluate the oncological benefit of CRS on PROC patients and the associated surgical morbidity and mortality. Methods: We followed a prospective protocol according to PRISMA guidelines. We searched PubMed, Medline, and Embase till October 2024. We used a “Population Intervention Comparator Outcomes (PICO)” framework. Our population included women with epithelial PROC who underwent CRS with/without chemotherapy. Our outcomes included overall survival (OS), progression-free-survival (PFS), post-operative morbidity and mortality and Quality of Life. Results: Our search yielded 6590 citations; six studies (N = 155 patients) were included. There is limited evidence available on the role of CRS in PROC, with notable variation in reported outcomes and outcomes’ measures; therefore, we were unable to perform quantitative synthesis. CRS demonstrated survival benefits in well-selected PROC patients, particularly those with limited, isolated recurrences, low tumour burden, and good performance status. Complete resection (R0) was associated with significantly longer OS/PFS compared to those who had suboptimal surgeries (R1/R2). Conclusions: CRS seems to extend survival in carefully selected PROC patients, especially those with limited disease spread and favourable surgical profiles. Nevertheless, CRS carries substantial surgical risks, and its benefits appear contingent upon achieving R0. Further prospective trials with standardised patient selection criteria are needed to define CRS’s role in PROC. At present, CRS in PROC should be considered within a multidisciplinary approach in specialised gynaecological oncology centres, with the careful assessment of patient-specific risk factors and potential for R0 resection.
背景/目的：铂类耐药性卵巢癌（PROC）的治疗选择有限，而减瘤手术（CRS）在改善生存结局方面的作用仍不明确。本研究通过系统综述评估CRS对PROC患者的肿瘤学获益及相关手术并发症与死亡率。方法：我们依据PRISMA指南制定了前瞻性研究方案，检索了截至2024年10月的PubMed、Medline和Embase数据库。采用“人群-干预-对照-结局（PICO）”框架，研究对象为接受CRS（联合或不联合化疗）的上皮性PROC女性患者，主要结局指标包括总生存期（OS）、无进展生存期（PFS）、术后并发症与死亡率及生活质量。结果：初检获得6590篇文献，最终纳入6项研究（共155例患者）。现有关于CRS在PROC中作用的证据有限，且报告结局与测量指标存在显著异质性，因此未能进行定量合成分析。CRS在经严格筛选的PROC患者中显示出生存获益，尤其适用于病灶局限、孤立性复发、肿瘤负荷低且体能状态良好的患者。与次优手术（R1/R2）相比，完全切除（R0）患者的OS/PFS显著延长。结论：CRS似乎能延长经严格筛选的PROC患者的生存期，尤其适用于疾病扩散有限且手术条件适宜的患者。然而CRS存在显著手术风险，其获益似乎取决于能否实现R0切除。未来需要采用标准化患者选择标准的前瞻性试验来明确CRS在PROC治疗中的作用。目前PROC的CRS治疗应在专科妇科肿瘤中心采用多学科协作模式，审慎评估患者个体风险因素及实现R0切除的可能性。
The Role of Cytoreductive Surgery in Platinum-Resistant Ovarian Cancer (PROC): A Systematic Review
肿瘤(癌症)患者之家