ObjectiveTo analyze the reasons for misdiagnosis of gastrointestinal metastatic ovarian cancer, in order to increase the rate of correct diagnosis and treatment, and to investigate the prognostic factors. MethodsWe retrospectively analyzed the clinical features, pathological features and prognostic factors of 43 cases of metastatic ovarian carcinoma from gastrointestinal tract treated between 2004 and 2014. ResultsGastrointestinal metastatic ovarian cancer was characterized by the diversity of clinical manifestations and lack of specific symptoms. The common initial symptom was pelvic mass, frequently accompanied with gastrointestinal symptoms of ascites, anemia or weight loss, abdominal pain, bloating, gastrointestinal obstruction and bleeding. Signs and symptoms of primary and secondary tumor sites often coexisted with each other, leading to misdiagnosis. Univariate analysis showed that primary site, histological type, surgical treatment, the residual tumor debulking size, lymph node metastasis, tumor invasion and standard chemotherapy had significant impacts on the prognosis (P < 0.05). ConclusionsGastrointestinal metastatic ovarian cancer occurs in premenopausal women, often with ascites, abdominal pelvic masses as the first symptom. Primary tumor site is often ignored, and the initial correct diagnosis rate is low. Metastasis from stomach cancer is the most common, followed by colorectal cancer and esophageal cancer. Prognosis is correlated with the primary site, histological type, degree of differentiation, depth of invasion, lymph node metastasis and other factors. Radical surgery and chemotherapy can improve survival.
【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.
ObjectiveTo systematically review the prognostic efficacy and safety of patients with ovarian cancer treated with systemic lymphadenectomy (SL). MethodsPubMed, The Cochrane Library, Web of Science, CNKI, WanFang Data, and CBM databases were electronically searched to collect randomized controlled trials (RCTs) and cohort studies on the prognostic outcomes of patients with ovarian cancer treated with SL from inception to December 16th, 2020. Six reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.4 software. ResultsA total of 5 RCTs and 23 cohort studies involving 6 166 patients were included. The results of meta-analysis showed that there were no significant differences in the 3-year survival rate, 5-year survival rate, 3-year progression-free survival rate, and 5-year progression-free survival rate between SL group and the no systemic lymphadenectomy (NSL) group. The results of the subgroup analysis showed that pelvic and para-aortic lymph node dissection combined with large omentum resection had a better prognosis for patients. ConclusionsCurrent evidence shows that SL has no significant efficacy on survival and progression-free survival in patients with ovarian cancer. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.
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.
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.
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 make an individualized therapeutic regimen for a patient with stage III relapsed ovarian cancer guided by evidence-based medicine.Methods According to the clinical problems this patient showed and the PICO (patient, intervention, comparison and outcome) principle, the best clinical evidence associated with relapsed ovarian cancer was retrieved and evaluated. Results The current evidence showed that the relapsed ovarian cancer with platinum resistance tended to be treated by pharmacotherapy. Consequently, on the basis of combining the recommended guidelines, randomized controlled trials (RCTs), systematic reviews or meta-analyses on RCTs, clinical experience from doctors and willingness of patient, the regimen of Irinotecan plus Pegylated Liposomal Doxorubicin for interventional chemotherapy was recommended for this patient. After three courses of the treatment, the disease got some relieved; the medical team would like to keep conducting the same regimen for another six to eight courses, and the follow-up visit was undergoing. Conclusion For patients with relapsed ovarian cancer with platinum resistance, an individualized therapeutic regimen under the guidance of evidence-based methods can not only improve the therapeutic efficacy but also guide both doctors and patients to take the indeterminate risk of medicine.
ObjectiveTo systematically review the effectiveness and safety of intraperitoneal hyperthermic perfusion chemotherapy (IHPC) for ovarian cancer, so as to provide references for clinical practice and studies. MethodsWe electronically searched PubMed, EMbase, The Cochrane Library (Issue 6, 2013), Web of Science, WanFang Data, CBM, VIP and CNKI for randomized controlled trials (RCTs) about IHPC vs. intravenous chemotherapy (IC) for ovarian cancer from the inception of the databases to June 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality. Then meta-analysis was performed using RevMan 5.1 software. ResultsA total of 10 RCTs involving 723 patients were included. The results of meta-analysis showed that the IHPC group was superior to the IC group in clinical efficiency (OR=4.02, 95%CI 2.85 to 5.68, P < 0.000 01), clinical benefit response (OR=3.41, 95%CI 2.13 to 5.45, P < 0.000 01), recurrence and metastasis rates (OR=0.29, 95%CI 0.20 to 0.42, P < 0.000 1), and overall survival rates (OR=3.30, 95%CI 1.82 to 5.99, P < 0.000 1). In the aspect of safety, no significant difference was found in bone marrow suppression, hemoglobin reduction, nausea and vomiting between two groups. ConclusionIHPC for ovarian cancer can improve clinical efficiency, clinical benefit response and overall survival rates, and reduce recurrence and metastasis rates; and it is also safe for patients.
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.
至2002年2月,有关晚期卵巢癌的手术治疗效果和细胞毒性化疗效果的临床证据如下:⑴在改进生活质量方面的任何治疗效果的证据都不充分. ⑵晚期卵巢癌的手术治疗: ①先行手术加化疗与单用化疗相比较:缺乏相关RCT. ②先行手术与不手术比较:缺乏相关RCT. ③在初次手术加化疗后一定间隔期的缩瘤术:1个RCT发现,初次手术加化疗后一定间隔期的缩瘤术提高总的存活年限为3.5年;另1个RCT则认为该方法对存活率没有显著性作用,但可能系检验效能不够而没有发现潜在的临床重要作用. ④常规二次手术:2个RCT认为,在晚期卵巢癌初次手术后常规进行二探手术的存活率并不优于术后只进行化疗的对照组. ⑶晚期卵巢癌的细胞毒性药物化疗: ①铂剂+紫杉醇方案:1篇系统评价和另1个RCT认为,晚期卵巢癌初次手术后,以铂剂+紫杉醇为基础的化疗能延长存活时间和总存活率. ②含铂剂的化疗方案:1篇系统评价发现,铂剂加入任何不含铂剂的方案都能显著提高存活率,尤其是铂剂加入联合治疗方案. ③卡铂+紫杉醇与卡铂+多烯紫杉醇比较:未找到比较这两种方案疗效的高质量RCT. ④含铂剂的联合方案与不含铂剂的联合方案比较:7个RCT比较了这两种方案;大多数RCT发现含铂剂的方案能改善结局,其益处和危害依赖于具体方案;没有研究显示铂剂能显著减少存活时间和总存活率. ⑤联用铂剂与单用铂剂比较:1篇系统评价和另3个RCT认为没有证据表明,延长存活时间和总存活率上,联用铂剂优于单用铂剂. ⑥紫杉醇+顺铂与紫杉醇+卡铂比较:1个RCT表明在延长存活时间和总存活率上两者无显著性差异,虽然不足以排除临床上的重要作用.