Objective To evaluate the role of systematic lymphadenectomy (SL) vs. unsystematic lymphadenectomy (USL) for improving overall survival (OS) in epithelial ovarian cancer (EOC). Methods The databases such as PubMed, EMbase, The Cochrane Library, Evidence-Based Medicine Reviews (EBMR), CBM, CNKI and VIP were searched between January 1, 1995 and December 31, 2010, the randomized controlled trials (RCTs) and observational studies on SL vs. USL in treating EOC were included. Based on Cochrane handbook, the data were extracted, the methodological quality was assessed, and then meta-analyses were conducted by using RevMan 5.0 software. Results The total 13 studies involving 22 796 patients were included, including 5 420 patients in the SL group, and the other 17 376 patients in the USL group. Two of the 13 studies were RCTs, and the other 11 were observational studies (including 2 studies retrieved from SEER data). The analyses on 2 RCTs showed that compared with USL, a) SL could not improve 5-PFS (OR=0.70, 95%CI 0.40 to 1.22, P=0.21) in early-stage EOC (FIGO I to II), but it did improve 5-PFS (OR=0.62, 95%CI 0.40 to 0.96, P=0.03) in advanced-stage EOC (FIGO III to IV); b) SL could not improve 5-OS in both early-stage EOC (OR=0.84; 95%CI 0.44 to1.58, P=0.58) and advanced-stage EOC (OR=0.93, 95%CI 0.64 to 1.37, P=0.73); and c) SL could not improve 5-OS in both early-stage (OR=0.84, 95%CI 0.44 to 1.58, P=0.58) and advanced-stage (OR=0.93, 95%CI 0.64 to 1.37, P=0.73) of EOC patients who had optimal tumor dubulking surgery. The analyses on observational studies showed that compared with USL, a) SL could not improve 5-PFS in both early-stage EOC (OR=0.38, 95%CI 0.08 to 1.74, P=0.21) and advanced-stage (OR=2.88, 95%CI 0.95 to 8.72, P=0.06) EOC; b) Whether SEER impacts were excluded or not, SL did improve 5-OS in both early-stage EOC (OR=0.54, 95%CI 0.46 to 0.63, Plt;0.000 01) and advanced-stage (OR=0.47, 95%CI 0.43 to 0.52, Plt;0.000 01) EOC; and c) For EOC patients who had optimal tumor dubulking surgery, SL could not improve 5-OS in early-stage (OR=0.32, 95% CI 0.02 to 6.19, P=0.45), but it did improve 5-OS in advanced-stage (OR=0.53, 95%CI 0.32 to 0.88, P=0.01). Conclusion These findings suggest that maybe SL can improve 5-PFS and 5-OS in EOC. However, the efficacy of SL on 5-PFS and 5-OS is still undetermined, so more relevant studies are required for further investigating the role of SL in EOC.
Objective To use a meta-analysis method to establish quantitatively the association between the HER-2/neu gene amplification/enhanced protein expression status and the 5-year post-operative survival rate or median survival time in women with epithelial ovarian carcinoma. Methods We searched and screened Chinese and English literature published since 1989 to collect all retrospective cohort studies on the prognostic significance of HER-2/neu status in this population. The survival data were analyzed using Ludwig’s centered signed rank and the DerSimonian-Laird method. Results In total, 25 studies involving 3 251 patients were included. HER-2/neu was positive in 27.1% (95%CI 0 to 54.8%) of patients, which was not related to the pathological stage, type or grade of epithelial ovarian carcinoma. In HER-2/neu positive cases, the median survival time was shortened by 0.65 years, and the 5-year survival rate was lowered. The hazard ratio (HR) for mortality was 1.22 (95%C 1.09 to 1.36). By subgroup analysis, HER-2/neu protein expression was found to be most significant in prognostic assessment. Patients with a b positive value of HER-2/neu had an increased HR for the 5-year survival; and platinum-based chemotherapy was demonstrated to be less effective in HER-2/neu positive ovarian carcinoma. Conclusion In gynecological oncology, it is reasonable to measure HER-2/neu as a routine pathological marker to predict a patient’s prognosis and to determine the most appropriate adjuvant chemotherapy regimen.
Objective To systematically review the diagnostic value of 18F-FDG PET/CT in recurrent epithelial ovarian cancer after treatment. Methods The PubMed, EMbase, Cochrane Library, Web of Science, CNKI, WanFang Data, VIP, and CBM databases were electronically searched to collect diagnostic tests of 18F-FDG PET/CT for epithelial ovarian cancer from inception to February 2023. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using Meta-Disc 1.4 and Stata 15.0 software. Results A total of 15 studies involving 792 patients were included in this study. The results of meta-analysis showed that the sensitivity, specificity, and area under the curve of 18F-FDG PET/CT in the diagnosis of recurrent epithelial ovarian cancer were 0.88 (95%CI 0.85 to 0.90), 0.80 (95%CI 0.75 to 0.85) and 0.91, respectively. The results of the subgroup analysis showed that the sensitivity of the prospective studies was the same as that of the retrospective studies, but the specificity of the prospective studies was higher than that of the retrospective studies. The diagnostic sensitivity and specificity of 18F-FDG PET/CT in recurrent epithelial ovarian cancer were higher in Asian studies than in European/North American studies. Conclusion 18F-FDG PET/CT has high diagnostic value in recurrent epithelial ovarian cancer. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
Objective To systematically assess literature regarding the relationship between ovulation induction and the risk of ovarian cancer. Methods We searched MEDLINE, EMbase, The Cochrane Library, CBM and CNKI (from inception to Feb, 2012). Cohort or case-control studies were identified according to the inclusion and exclusion criteria. Then the quality of the included studies was assessed, and the data was extracted. Meta-analysis was performed by RevMan 5.0 software. The incorporated RR (relative risk) and 95%CI (confidence interval) of the included cohort studies and incorporated OR (odds ratio) and 95%CI of case-control studies were calculated, respectively. Results Four cohort studies and four case-control studies were included. Result of meta-analysis on cohort studies showed ovulation induction didn’t increase the risk of ovarian cancer (RR=1.07, 95%CI 0.81 to 1.42, P=0.63). Besides, result of meta-analysis on case-control studies showed ovulation induction was not associated with the incidence of ovarian cancer (OR=1.28, 95%CI 0.78 to 2.08, P=0.33). But the risk of borderline ovarian tumors increased when compared with general population controls (OR=1.71, 95%CI 1.05 to 2.79, P=0.03). Conclusion Ovulation induction does not increase the risk of ovarian cancer, but may relate to the incidence of borderline ovarian cancer. However, more high-quality studies, especially perspective cohort studies are required because of the limited quantity of the included studies.
目的 评价肿瘤细胞减灭术治疗复发上皮性卵巢癌（EOC）的作用，分析影响生存时间的因素。 方法 按Cochrane系统评价方法，计算机检索PubMed、EMbase、Medline、Cochrane Library、循证医学数据库（EBMR）、中国生物医学文献数据库（CBM）、中国期刊全文数据库（CJFD）、清华同方等数据库，并手工检索相关领域杂志。检索时间从1985年1月1日－2011年11月30日，查找手术治疗复发EOC患者的回顾性、非随机前瞻性、病例对照研究，由两位研究者按照纳入排除标准筛选文献、评价质量并提取资料后，采用SPSS软件进行线性回归分析。 结果 共纳入48篇文献（回顾性文献40篇，非随机前瞻性文献7篇，病例对照研究1篇）共2 605例。简单线性回归分析结果显示满意切除比例与中位生存时间回归模型成立，有统计学意义（F=7.346，P=0.009），浆液性病理类型比例与中位生存时间回归模型成立，有统计学意义（F=5.537，P=0.025），残留病灶大小与中位生存时间回归模型成立，有统计学意义（F=4.249，P=0.045），多重逐步线性回归分析显示仅有满意切除比率对术后中位生存时间的影响有统计学意义（P=0.009）。 结论 二次肿瘤细胞减灭术主要适用于铂类敏感型可切除及孤立结节复发EOC患者，要获得明确二次肿瘤细胞减灭术治疗复发EOC对中位生存时间的影响，尚需进行大样本随机对照的研究。
Objective To evaluate the efficacy and the adverse reactions of intensive therapy compared with conventional therapy. Methods We searched the Cochrane Central Register of Controlled Trials (Issue 3, 2008), MEDLINE (January 1980 to June 2008), EMbase (1984 to June 2008), CBM-disc (January 1980 to June 2008) and CNKI (1994 to June 2008) to get all the randomized control trials (RCTs) about paclitaxel intensive versus conventional therapy for ovarian cancer. We used RevMan 5 to perform meta-analysis. Results Six RCTs involving 572 patients were included. Metaanalysis showed the efficacy of intensive therapy and conventional therapy was similar. There were no significant differences in response rate (RR 1.06, 95%CI 0.94 to 1.20), median survival time, survival rate, median progression free survival and median time to progression between the two groups. When taking safety into consideration, intensive therapy significantly reduced the occurrence of grade Ⅲ or higher neutropenia (RR 0.49, 95%CI 0.35 to 0.69, Plt;0.000 1) and Grade Ⅲ or higher neuropathy (RR 0.43, 95%CI 0.24 to 0.78, P=0.006). But there were no significant differences between intensive therapy and conventional therapy in flush, grade Ⅲ or higher vomiting, anemia, leucopenia, grade Ⅲ or higher thrombocytopenia and alopecia. Conclusion Paclitaxel intensive therapy has similar efficacy and adverse reactions compared with conventional therapy in ovarian cancer. Above all, intensive therapy can reduce the incidence of grade Ⅲ or higher neutropenia and neuropathy. It is a good substitution for the conventional therapy.
Objective To assess the clinical efficacy, safety and cost-effectiveness of topotecan for recurrent epithelial ovarian cancer. Methods We searched MEDLINE (1966 to 2005), EMbase (1989 to 2004), CancerLit (1996 to 2003), CBMdisc (1978 to 2005), CNKI (1994 to 2005), The Cochrane Library (Issue 3, 2005), The National Research Register, and the Health Technology Assessment Database (HTA). Relevant journals were also handsearched. The search was conducted on December 31, 2005. Randomize controlled trials (RCTs) comparing topotecan versus other agents for recurrent epithelial ovarian cancer were included. The quality of the eligible trials was assessed by two reviewers independently. Meta-analysis was performed. Results Four RCTs met the inclusion criteria, and the methodological quality was either level A or B. When used as second-line chemotherapy for recurrent ovarian cancer, there was no significant difference in remission rate between topotecan and paclitaxel or pegylated liposomal doxorubicin (PLD). The clinical benefit rate of topotecan was higher than that of paclitaxel or PLD. Myelosuppression was more frequent in patients in the topotecan group than those in the PLD or paclitaxel group, but it was not severe. As to cost-effectiveness analysis, topotecan was better than PLD. Conclusions The standard regimen of topotecan (intravenous 1.5 mg/m2/d for 5 consecutive days) is recommended for use in platinum-resistant and refractory ovarian cancer.
Ovarian cancer is one of the common malignant tumors of female genital organs. In gynecological tumors, the incidence rate of ovarian cancer ranks the third after cervical cancer and uterine body cancer, but the death rate of ovarian cancer ranks the first, posing a serious threat to women’s life and health. In recent years, the National Comprehensive Cancer Network (NCCN) clinical practice guidelines for ovarian cancer has become an important basis for diagnosis and treatment of ovarian cancer. In this paper, we interpret the latest version (version 4. 2017) of NCCN clinical practice guidelines for ovarian cancer for its better clinical application.
【摘要】 目的 研究ΔNP63/TAP63在上皮性卵巢肿瘤组织中的表达及其与临床病理特征的关系。 方法 运用荧光定量聚合酶链反应方法检测2002年-2004年54例卵巢上皮性肿瘤中ΔNP63/TAP63的基因水平。 结果 33例卵巢上皮细胞癌组织中ΔNP63的表达高于21例良性上皮性肿瘤中组织。卵巢上皮细胞癌中的表达强度与肿瘤组织病理学分期相关（Plt;0.05），良性肿瘤的表达低于恶性肿瘤（Plt;0.05）。ΔNP63的表达高于TAP63（Plt;0.05）；各组间TAP63的表达差异无统计学意义（Pgt;0.05）。 结论 ΔNP63在上皮性卵巢癌中高表达，可能成为上皮性卵巢癌诊断及预后的分子标志物。【Abstract】 Objective To explore the expression of ΔNP63 / TAP63 in human epithelial ovarian tumor tissues and its relationship with the clinicopathological features. Methods Fluorescent quantitative PCR method was used to detect 54 cases of ΔNP63 / TAP63 gene level in 54 patients with epithelial ovarian tumors diagnosed between 2002 and 2004. Results ΔNP63 expression in the 33 cases of ovarian epithelial cell carcinoma was higher than that in the 21 cases of benign epithelial tumor tissue. The expression in ovarian epithelial cell carcinoma was concerned with the pathological staging of tumor (Plt;0.05); the expression in benign tumors was lower than that in the malignant tumors (Plt;0.05). In all cases, the expression of ΔNP63 was higher than that of TAP63 (Plt;0.05); the difference in the expression of TAP63 among the groups was not significant (Pgt;0.05). Conclusion ΔNP63 in epithelial ovarian cancer is highly expressed, which may become the molecular makers with diagnosis and prognosis of epithelial ovarian cancer diagnosis in the future.
【摘要】 目的 研究肿瘤坏死因子相关凋亡诱导配体（TRAIL）蛋白对SKOV3移植瘤细胞半胱天冬氨酸蛋白酶-3（Caspase-3）表达的影响及其与肿瘤细胞凋亡的关系。 方法 建立雌性裸小鼠SKOV3移植瘤24只，随机分为4组，每组6只。TRAIL组单用重组人TRAIL蛋白（10 μg/kg），顺铂（DDP）组单用DDP（3 mg/kg），TRAIL+DDP组联合使用TRAIL蛋白（10 μg/kg）和DDP（3 mg/kg），空白对照组给予0.5 mL生理盐水。经处理后，各组的组织切片用免疫组织化学染色检测Caspase-3的表达和末端脱氧核苷酸转移酶介导核苷酸缺口标记技术（TUNEL）检测肿瘤细胞凋亡指数。 结果 Caspase-3的表达水平在TRAIL组（171.67±14.38）、DDP组（172.50±14.75）、联合组（230.00±40.99）中均明显高于对照组（135.83±16.25）（Plt;0.05）。SKOV3移植瘤细胞凋亡指数在空白对照组、TRAIL组、DDP组和联合组分别为16.67±5.43、33.17±8.42、24.33±4.59和40.50±6.16，TRAIL组和联合组细胞凋亡指数较空白对照组和DDP组明显增高（Plt;0.05）。 结论 TRAIL蛋白使卵巢癌移植瘤细胞的Caspase-3表达增强，TRAIL蛋白促进肿瘤细胞凋亡发生。【Abstract】 Objective To investigate the effects of Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) on the expression of Cysteine/aspartic acid specific protease- 3 (Caspase-3) in SKOV3 ovarian tumor cells and its relationship with the apoptosis of the ovarian tumor xenografts in nude mice. Methods Twenty-four nude mice with SKOV3 cell line ovarian tumor were randomly divided into four groups with 6 in each group. TRAIL (10 μg/kg) was given to the mice in the TRAIL group; DDP (3 μg/kg) was given to the mice in the DDP group; TRAIL (10 μg/kg) and DDP (3 μg/kg) were given to the mice in the TRAIL+DDP group; and 0.5 mL of saline solution was give to the mice in the control group. The expression of Caspase-3 was detected with immunohistochemistry. The apoptosis index (AI) of cells was determined by Terminal deoxynucleotidyl transferase mediated-dUTP nick end labeling (TUNEL). Results The expression of Caspase-3 in the TRAIL group (171.67±14.38), DDP group (172.50±14.75), and TRAIL+DDP group (230.00±40.99) was significantly higher than that in the control group (135.83±16.25) (Plt;0.05). The apoptosis index for the control group, TRAIL group, DDP group and TRAIL+DDP group was 16.67±5.43, 33.17±8.42, 24.33±4.59, and 40.50±6.16, respectively. The apoptosis index for the TRAIL group and the TRAIL+DDP group was significantly higher than that in the control group and the DDP group (Plt;0.05). Conclusion Soluble TRAIL has an effect on enhancing the expression of Caspase-3 in implanted tumor in nude mice. TRAIL protein can inhibit the growth of SKOV3 cells in nude mice by inducing cell apoptosis.