背景:卵巢透明细胞癌(OCCC)与上皮性卵巢癌(EOC)具有相同的治疗策略。由于OCCC的稀有性,缺乏对其手术的前瞻性研究,导致异构和有限的现有数据。本研究旨在阐明淋巴结清扫术在OCCC患者中的预后意义。
方法:我们系统地搜索了WebofScience,Scopus,PubMed,和谷歌学者,直到2023年7月,研究淋巴结清扫术对OCCC患者的影响。我们用95%置信区间(CI)计算了合并风险比(HR)。本研究在PROSPERO(CRD42021270460)注册。
结果:在444篇筛选的文章中,7项研究(2883名女性)符合纳入标准.我们的分析显示,淋巴结清扫术显著改善了疾病特异性生存率(DSS)(HR=0.76,95CI=0.60-0.95,P=0.02)和无病生存率(DFS)(HR=0.58,95CI=0.34-0.99,P=0.05)。然而,对总生存期(OS)(HR=0.80,95CI=0.60-1.06,P=0.12)或无进展生存期(PFS)(HR=0.95,95CI=0.64-1.42,P=0.79)无显著影响.值得注意的是,一些早期的研究报告没有生存益处,保证谨慎的解释。
结论:淋巴结清扫术不能显著提高OCCC的OS和PFS,但可以提高DFS和DSS。为个体患者概况量身定制治疗对于获得最佳结果至关重要。精确的术前或术中淋巴结转移检测对于确定受益于淋巴结清扫术的候选者至关重要。国际合作努力和OCCC数据库对于完善未来的治疗策略至关重要。
BACKGROUND: Ovarian clear cell carcinoma (OCCC) shares treatment strategies with epithelial ovarian cancer (EOC). Due to OCCC\'s rarity, there\'s a lack of prospective studies on its surgery, resulting in heterogeneous and limited existing data. This study aims to clarify the prognostic significance of lymphadenectomy in OCCC patients.
METHODS: We systematically searched Web of Science, Scopus, PubMed, and Google Scholar until July 2023 for studies investigating lymphadenectomy\'s effects on OCCC patients. We calculated pooled hazard ratios (HR) with 95% confidence intervals (CI). This study is registered in PROSPERO (CRD42021270460).
RESULTS: Among 444 screened articles, seven studies (2883 women) met inclusion criteria. Our analysis revealed that lymphadenectomy significantly improved disease-specific survival (DSS) (HR = 0.76, 95%CI = 0.60-0.95, P = 0.02) and disease-free survival (DFS) (HR = 0.58, 95%CI = 0.34-0.99, P = 0.05). However, it did not significantly affect overall survival (OS) (HR = 0.80, 95%CI = 0.60-1.06, P = 0.12) or progression-free survival (PFS) (HR = 0.95, 95%CI = 0.64-1.42, P = 0.79). Notably, some earlier studies reported no survival benefit, warranting cautious interpretation.
CONCLUSIONS: Lymphadenectomy does not significantly enhance OS and PFS for OCCC but does improve DFS and DSS. Tailoring treatment to individual patient profiles is imperative for optimal outcomes. Precise preoperative or intraoperative lymph node metastasis detection is essential for identifying candidates benefiting from lymphadenectomy. Collaborative international efforts and an OCCC database are pivotal for refining future treatment strategies.