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.
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。