肿瘤细胞减灭术治疗复发上皮性卵巢癌的系统分析

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、CochraneLibrary、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30Et，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2605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。

System Analysis of Cytoreductive Surgery for the Treatment of Recurrent Epithelial Ovarian Carcinoma

Objective To systematically assess the role of cytoreductive surgery in the treatment of recurrent epithelial ovarian carcinoma （EOC） and analysis of factors affecting survival of the patients. Methods The literature published between January 1, 1985 and November 30, 2011 were searched in PubMed, Embase, Medline, Cochrane Library, EBMR, CBM, CJFD, and CNKI databases to identify the retrospective, prospective, non-randomized case-control studies. The literature was screened according to the inclusive and exclusive criteria by two reviewers independently, and then the SPSS software was used for linear regression. Results Forty retrospective, 7 prospective and 1 non-randomized case-control studies with 2605 patients were included. Simple linear regression showed statistical significance between optimal cytoreductive surgery rate and median overall survival （F=7.346, P=-0.009）, between serous rate and median overall survival （F=5.537, P-=-0.025）, and between residual tumors and median overall survival （F=4.249, P=-0.045）, and multiple linear regression showed that statistical significance only existed between optimal cytoreductive surgery rate and median overall survival （P=0.009）. Conclusions Cytoreductive surgery is suitable for platinum-sensitive and isolated nodules recurrent epithelial ovarian carcinoma. To acquire the clear effect of secondary cytoreductive surgery in recurrent EOC, large-sample randomized controlled studies are required.