Background: The objective in epithelial ovarian cancer is to reach maximal cytoreduction with no visible residual tumor. Tumor detection during cytoreductive surgery depends on visual inspection, palpation, or blind biopsy, methods that lack reliability for identifying microscopic disease. Although the importance of microscopic disease in epithelial ovarian cancer is controversial, it may harbor chemoresistant cells and explain the high recurrence rates. Fluorescence-guided surgery (FGS) is an emerging approach. However, the potential in ovarian cancer remains underexplored; the majority of the existing evidence pertains to gastrointestinal tumors and a limited group of ovarian cancer patients. Their comparative effectiveness is still uncertain.Objective:To systematically review and evaluate the role of fluorescence-guided surgical techniques in detecting microscopic disease in ovarian cancer and compare their efficacy to total peritonectomy.Data Sources:A systematic search was made in three databases (PubMed, Web of Science, and Embase). The search was conducted from 1975 to 2024, including randomized controlled trials, observational studies, and conference abstracts in the last 25 years.Study Selection:Clinical studies published in English involving ovarian cancer patients undergoing FGS or total peritonectomy were included. Case reports, reviews, animal studies, and studies involving mixed cancer populations without ovarian cancer-specific data were excluded. Two independent reviewers screened 631 studies, yielding 12 eligible studies for final analysis.Data Extraction and Synthesis:Data were extracted and synthesized in accordance with PRISMA and MOOSE guidelines, using random-effects models for independent analysis. Sensitivity, specificity, positive predictive value (PPV), and odds ratios (ORs) were grouped, accompanied by subgroup analyses based on the fluorescence agent employed. For quality assessment, we utilized the NIH quality tool.Main Outcome(s) and Measure(s):The primary outcome was the rate of change in surgical management due to fluorescence guidance or total peritonectomy. Secondary outcomes comprised lesion-level sensitivity, specificity, and PPV. Safety outcomes included adverse events associated with fluorescence agents.Results:There were 12 studies involving 429 ovarian cancer patients. FGS improved the detection of microscopic disease compared to standard visualization methods, with a pooled sensitivity of 0.77. Folate receptor-targeted agents had high sensitivity (84%) but low specificity (26%). Aminolevulinic acid (5-ALA) showed superior diagnostic accuracy with a sensitivity of 84% and a specificity of 96%. Total peritonectomy showed no significant advantage over FGS for detecting microscopic disease. The adverse events were mild, with no serious events reported. We observed a high heterogeneity across studies and methodologies.Conclusions and Relevance:Fluorescence-guided surgery utilizing fluorescence tracers demonstrates potential in improving the detection of microscopic disease and may change surgical management in epithelial ovarian cancer, particularly with 5-ALA. Variability in performance and limited data on survival outcomes necessitates additional research. Total peritonectomy does not offer further advantage in the detection of microscopic disease. Future trials should focus on standardizing methodology and evaluating the effects of microscopic disease removal on survival outcomes.Registration:The study was registered to PROSPERO as CRD42024578274.
背景：上皮性卵巢癌的治疗目标在于实现最大程度的肿瘤细胞减灭，达到无肉眼可见残留病灶。肿瘤细胞减灭术中病灶的检测依赖于肉眼观察、触诊或盲法活检，这些方法在识别微观病灶方面缺乏可靠性。尽管微观病灶在上皮性卵巢癌中的重要性存在争议，但其可能包含化疗耐药细胞，并解释了高复发率的原因。荧光引导手术是一种新兴技术，但在卵巢癌中的应用潜力尚未得到充分探索；现有证据大多涉及胃肠道肿瘤及有限的卵巢癌患者群体，其相对有效性仍不确定。 目的：系统综述并评估荧光引导手术技术在检测卵巢癌微观病灶中的作用，并将其疗效与全腹膜切除术进行比较。 数据来源：在三个数据库（PubMed、Web of Science 和 Embase）中进行系统检索。检索时间范围为1975年至2024年，涵盖过去25年内的随机对照试验、观察性研究及会议摘要。 研究选择：纳入以英文发表的涉及接受荧光引导手术或全腹膜切除术的卵巢癌患者的临床研究。排除病例报告、综述、动物研究以及涉及混合癌症人群但缺乏卵巢癌特异性数据的研究。由两名独立评审员筛选了631项研究，最终确定12项符合条件的研究纳入分析。 数据提取与综合：依据PRISMA和MOOSE指南提取并综合数据，采用随机效应模型进行独立分析。汇总了敏感性、特异性、阳性预测值及比值比，并根据所使用的荧光剂进行了亚组分析。质量评估采用NIH质量评估工具。 主要结局指标：主要结局指标为因荧光引导或全腹膜切除术导致手术方案改变的发生率。次要结局指标包括病灶水平的敏感性、特异性及阳性预测值。安全性结局包括与荧光剂相关的不良事件。 结果：共纳入12项研究，涉及429名卵巢癌患者。与标准可视化方法相比，荧光引导手术提高了微观病灶的检出率，汇总敏感性为0.77。叶酸受体靶向剂具有高敏感性（84%）但特异性较低（26%）。氨基酮戊酸（5-ALA）显示出更优的诊断准确性，敏感性为84%，特异性为96%。全腹膜切除术在检测微观病灶方面未显示出显著优于荧光引导手术的优势。不良事件轻微，未见严重事件报告。我们观察到研究间及方法学上存在高度异质性。 结论与相关性：利用荧光示踪剂的荧光引导手术在改善微观病灶检测方面展现出潜力，并可能改变上皮性卵巢癌的手术治疗策略，尤其是使用5-ALA时。然而，其性能存在差异且关于生存结局的数据有限，需要进一步研究。全腹膜切除术在检测微观病灶方面未提供额外优势。未来的试验应侧重于方法学的标准化，并评估清除微观病灶对生存结局的影响。 注册信息：本研究已在PROSPERO注册，注册号为CRD42024578274。
肿瘤(癌症)患者之家