Objective. To compare the survival outcomes of primary debulking surgery and platinum-based adjuvant chemotherapy versus interval debulking surgery after platinum-based neoadjuvant chemotherapy in patients with stage IVb endometrial cancer and peritoneal carcinosis. Methods. The online search included the following data sources: PubMed, Scopus, WOS, and the Cochrane Library from 1990 to 2024 (PROSPERO registration code: CRD42023438602). A total of 3230 studies were identified, with the inclusion of 16. Individual patient data on survival outcomes, disease distribution, and residual tumors, as well as details of neoadjuvant chemotherapy and adjuvant treatment, were extracted. Results. A total of 285 patients were included: 197 (69%) underwent primary debulking surgery and 88 (31%) underwent interval debulking surgery. The pooled analysis revealed a median progression-free survival in the primary debulking surgery group of 18.0 months compared to 12.0 months in the interval debulking surgery group (p= 0.028; log-rank test), and a median overall survival of 30.92 months versus 28.73 months (p= 0.400; log-rank test). Among the 134 patients with available information on the residual tumor after primary debulking surgery or interval debulking surgery, 110 (82%) had no macroscopic residual tumor (residual tumor = 0). The median progression-free survival was 18.9 months in the residual tumor = 0 group compared to 6.19 months in the residual tumor > 0 group (p< 0.001; log-rank test); the median overall survival was 40.6 months versus 21 months (p= 0.028; log-rank test). Conclusions. These results indicate that primary debulking surgery should be considered the preferred treatment approach for advanced endometrial cancer with carcinosis, especially in carefully selected patients where complete cytoreduction is achievable. Further prospective studies are warranted to confirm these results and to establish standardized criteria for patient selection, incorporating molecular-integrated risk profiles for endometrial cancer.
目的：比较IVb期子宫内膜癌伴腹膜癌病患者接受初次肿瘤细胞减灭术联合铂类辅助化疗与铂类新辅助化疗后间歇性肿瘤细胞减灭术的生存结局。方法：通过在线检索PubMed、Scopus、WOS及Cochrane图书馆数据库（1990-2024年，PROSPERO注册号：CRD42023438602），共纳入16项研究（初筛文献3230篇）。提取患者个体生存结局、疾病分布、残留肿瘤情况以及新辅助化疗与辅助治疗详细信息。结果：共纳入285例患者，其中197例（69%）接受初次肿瘤细胞减灭术，88例（31%）接受间歇性肿瘤细胞减灭术。汇总分析显示：初次肿瘤细胞减灭术组中位无进展生存期为18.0个月，显著优于间歇性肿瘤细胞减灭术组的12.0个月（p=0.028；对数秩检验）；中位总生存期分别为30.92个月与28.73个月（p=0.400；对数秩检验）。在134例可获得残留肿瘤信息的患者中，110例（82%）达到肉眼无残留肿瘤状态（残留肿瘤=0）。残留肿瘤=0组中位无进展生存期达18.9个月，显著优于残留肿瘤>0组的6.19个月（p<0.001；对数秩检验）；中位总生存期分别为40.6个月与21个月（p=0.028；对数秩检验）。结论：对于伴有腹膜癌病的晚期子宫内膜癌患者，尤其经严格筛选可实现完全肿瘤细胞减灭者，初次肿瘤细胞减灭术应作为首选治疗方案。未来需开展前瞻性研究验证该结论，并建立整合分子风险特征的标准化患者选择标准。
肿瘤(癌症)患者之家