Objective: While PARP inhibitors (PARPi) improve progression-free survival (PFS) in advanced ovarian cancer, their efficacy across different surgical outcomes is unclear. We aimed to determine if the efficacy of PARPi maintenance therapy, as measured by PFS, is modified by postoperative residual disease (R0 vs. R1/R2) in newly diagnosed advanced epithelial ovarian cancer. Methods: A systematic review and trial-level meta analysis of randomized controlled trials published through July 2025 was conducted. The primary endpoint was pooled hazard ratio (HR) for PFS, with subgroup analyses based on residual disease (R0 vs. R1/R2), clinical risk (higher risk vs. lower risk), and timing of surgery (primary cytoreductive surgery vs. interval cytoreductive surgery). Results: Six randomized controlled trials involving 3629 patients were included in this meta analysis. PARPi maintenance significantly improved PFS in both patients with no gross residual disease (R0) (HR 0.55, 95% CI 0.44–0.68, I2= 64.2%) and those with macroscopic residual disease (R1/R2) (HR 0.51, 95% CI 0.40–0.65, I2= 56.0%). The treatment effect did not differ significantly between these subgroups (p= 0.66). A numerically greater benefit was observed in lower-risk populations (HR 0.40, 95% CI 0.29–0.55, I2= 0.9%) compared to higher-risk populations (HR 0.51, 95% CI 0.36–0.73, I2= 78.5%,p= 0.30). The benefit was maintained irrespective of surgical timing, with similar pooled HRs for patients undergoing primary (HR 0.56, 95% CI 0.42–0.74, I2= 72.3%) versus interval (HR 0.54, 95% CI 0.45–0.66, I2= 44.2%) cytoreductive surgery. Conclusions: PARP inhibitor maintenance therapy provides a significant PFS benefit regardless of residual disease status, supporting its use in all eligible patients. Complete cytoreduction, however, remains crucial, as it provides the best foundation for achieving optimal long-term outcomes and maximizing the benefits of maintenance therapy.
目的：虽然PARP抑制剂（PARPi）能改善晚期卵巢癌患者的无进展生存期（PFS），但其在不同手术结局患者中的疗效尚不明确。本研究旨在探讨PARPi维持治疗对新诊断晚期上皮性卵巢癌患者PFS的疗效是否受术后残留病灶状态（R0对比R1/R2）的影响。方法：对截至2025年7月发表的随机对照试验进行系统综述和试验层面荟萃分析。主要终点为PFS的汇总风险比（HR），并根据残留病灶状态（R0对比R1/R2）、临床风险（高风险对比低风险）及手术时机（初次肿瘤细胞减灭术对比间歇性肿瘤细胞减灭术）进行亚组分析。结果：本荟萃分析共纳入6项随机对照试验，涉及3629例患者。PARPi维持治疗在无肉眼残留病灶（R0）患者（HR 0.55，95% CI 0.44–0.68，I²=64.2%）和肉眼残留病灶（R1/R2）患者（HR 0.51，95% CI 0.40–0.65，I²=56.0%）中均显著改善PFS，两组间疗效差异无统计学意义（p=0.66）。与高风险人群（HR 0.51，95% CI 0.36–0.73，I²=78.5%）相比，低风险人群（HR 0.40，95% CI 0.29–0.55，I²=0.9%）的获益数值更大（p=0.30）。无论手术时机如何，PARPi的获益均持续存在：接受初次肿瘤细胞减灭术患者（HR 0.56，95% CI 0.42–0.74，I²=72.3%）与间歇性肿瘤细胞减灭术患者（HR 0.54，95% CI 0.45–0.66，I²=44.2%）的汇总HR相似。结论：PARP抑制剂维持治疗在不同残留病灶状态患者中均能显著改善PFS，支持在所有符合条件的患者中使用。但完全肿瘤细胞减灭术仍至关重要，因其为实现最佳长期结局和最大化维持治疗获益提供了最理想的基础。
肿瘤(癌症)患者之家