2025 Year-End Review – Professor Zang Rongyu: "Hardcore Data" Validates the Value of Surgery, Chinese Standards Pave a New Journey for Ovarian Cancer Diagnosis and Treatment
With the continuous innovation of clinical concepts and in-depth advancement of research in ovarian cancer diagnosis and treatment—from the predicament of low complete cytoreduction rate with traditional surgery to high complete cytoreduction rate and individualized regimens under the guidance of precision medicine—"pursuing disease-free survival benefit and improving postoperative quality of life" has always been the core common goal of surgeons and patients with ovarian cancer. The release of landmark data from the TRUST study and the establishment of the "Chinese Standard" by the yet-to-be-published SUNNY study are bringing groundbreaking advances to the diagnosis and treatment of patients with advanced ovarian cancer. Obstetrics and Gynecology Network specially invited Professor Zang Rongyu from Zhongshan Hospital Fudan University to discuss the annual core progress and future development direction in the field of ovarian cancer surgery, and to provide new ideas for the diagnosis and treatment of advanced ovarian cancer.
2025 Core Clinical Research: Innovation in Survival Data and Chinese Explorations
PART 01 TRUST Study: A Major Breakthrough in Surgical Timing and Survival Data
Surgery forms the foundation of ovarian cancer treatment. The German TRUST study, presented at the American Society of Clinical Oncology (ASCO) Annual Meeting in June 2025, emerged as the landmark achievement in ovarian cancer surgery this year. Focusing on the efficacy comparison between primary debulking surgery (PDS) and interval debulking surgery after neoadjuvant chemotherapy (NACT-IDS), the study yielded record-high overall survival (OS) data: the median progression-free survival (PFS) of the PDS group and IDS group reached 22.1 months and 19.7 months respectively (PFS in previous similar studies was mostly around 12 months), and the median OS even hit 54.3 months and 48.3 months, significantly surpassing the levels of prior clinical studies.
A consensus has been reached on the core conclusions of the TRUST study: there is no significant difference in overall survival between PDS and NACT-IDS, but the complete cytoreduction rate of the PDS group is superior to that of the NACT-IDS group. Notably, although the study showed a significant difference in PFS, OS remains the gold standard for clinical research, and the study paper has not yet been formally published. Thus, the clinical significance of the PFS difference and its impact on long-term disease-free survival still require further verification by the SUNNY study. If subsequent data confirm that one surgical approach confers a long-term disease-free survival advantage in the intention-to-treat (ITT) population or specific subgroups, it will provide critical evidence-based basis for the selection of surgical timing in ovarian cancer.
PART 02 SUNNY Study: Characteristics and Progress of China's Original Research
Led by a Chinese research team with the participation of Asian countries, the SUNNY study has completed 4.5 years of follow-up, and its final results are expected to be released from the end of 2026 to the beginning of 2027. Compared with the TRUST study, the SUNNY study features three distinct advantages: first, it uses PET-CT as the core diagnostic tool to construct a more clinically practical tumor burden assessment system; second, it incorporates patient quality of life into key evaluation indicators for the first time, with a focus on treatment-free survival after surgery (TFSa) in patients receiving different surgical approaches; third, the enrolled population is from hospitals after excluding those with severe medical comorbidities, and complete cytoreduction is not set as the sole goal, making the study more in line with real-world clinical practice. Despite this, current data show that the complete cytoreduction rate of the SUNNY study reaches 64%. Although slightly lower than that of the TRUST study, the generalizability of its results for clinical practice is stronger due to the broad representativeness of the enrolled population.
Chinese Standard: Innovative Practice in Preoperative Precision Assessment and Improved Complete Cytoreduction Rate
To address the dilemma of selecting between PDS and NACT-IDS for advanced ovarian cancer, a team of Chinese experts has constructed a PET-CT-based Peritoneal Cancer Index (PCI) scoring system through the SUNNY study, establishing a China-specific "Chinese Standard" for preoperative precision assessment and providing critical technical support for improving the surgical complete cytoreduction rate.
This scoring system includes nine standard items, with core innovations reflected in two newly added assessment contents: first, pulmonary embolism is included in the scoring category—considering that approximately 25% of ovarian cancer patients may have complicated pulmonary embolism in clinical practice, its impact on surgical safety requires key preoperative assessment; second, the assessment of lymph nodes above the renal vein level is added, which solves the limitation of laparoscopy in observing the retroperitoneal area, where PET-CT has an inherent advantage in assessment.
To ensure the accuracy and scientificity of the assessment, the system has established a rigorous evaluation process: two nuclear medicine physicians and one clinician participate in the assessment jointly, and each indicator is graded as low, moderate, or high according to the certainty level. Only indicators with high certainty are given clear scores, two moderate-certainty indicators are counted as one scored item, and so on; if there is only one moderate-certainty indicator, no score is assigned. This maximizes the reliability of the assessment results. The popularization and application of this scoring system provide an important basis for the precise preoperative screening of surgical indications and the formulation of individualized surgical regimens.
Reshaping with Hardcore Data: The Core Status of Surgery in Multimodal Therapy
Clinical data released in 2025 have further confirmed the irreplaceability of surgery in the multimodal therapy of ovarian cancer, and its core value is mainly reflected in two aspects:
On the one hand, surgery is the key means to achieve long-term disease-free survival. Although targeted therapy, immunotherapy, and antibody-drug conjugates (ADCs) have made remarkable progress in ovarian cancer treatment and effectively prolonged patients' overall survival, new drugs are currently unable to achieve breakthroughs in long-term disease-free survival. In contrast, surgery enables the complete resection of tumor lesions, creating the possibility of long-term treatment-free survival for patients—an advantage that cannot be replaced by drug therapy. The strategy of surgery first, followed by adjuvant therapy with new drugs maximizes the survival of ovarian cancer patients.
On the other hand, the improvement of surgical quality is directly translated into survival benefits. Compared with the European EORTC 55971 and CHORUS studies in 2010 and 2015 (with a surgical complete cytoreduction rate of less than 20% and an OS of only 29-30 months), the complete cytoreduction rate of the TRUST study in 2025 has risen to 70%, with a corresponding maximum OS of 54.3 months. This data clearly confirms that the surgical complete cytoreduction rate, as a core "hardcore index", is positively correlated with patients' survival benefits, highlighting the core value of surgery in the treatment of advanced ovarian cancer. Although the choice between PDS and IDS may not improve survival rates, surgical quality is undoubtedly a key factor in enhancing survival.
Future Breakthroughs: Standardized Quality Control and Surgical-Drug Synergistic Optimization
PART 01 Standardized Quality Control of Surgical Procedures: A Prerequisite for Ensuring Surgical Benefits
The top priority for the future of ovarian cancer surgery is to establish a comprehensive standardized quality control system, with the core principles of "safety first and individualized screening". For patients with severe medical diseases, hypoalbuminemia, moderate to severe anemia, and other conditions, the risk of surgical complications should be prioritized, and neoadjuvant chemotherapy should be adopted directly instead of forced surgery; only after a comprehensive assessment confirming that the patient can tolerate surgery and has the potential for complete cytoreduction can they be included in the selection of PDS or IDS regimens. The core goal of standardized quality control is to avoid ineffective surgeries where "the tumor is completely resected but the patient dies from severe complications", ensuring that every surgery is converted into tangible survival benefits.
PART 02 Surgical-Drug Synergy: A Dual Additive Therapeutic Effect
The rapid development of drug therapy provides important support for surgical treatment. The core direction of future ovarian cancer treatment is "based on complete surgical cytoreduction, extended by drug therapy". A meta-analysis published in early 2025 showed that PARP inhibitors can significantly improve PFS (reducing the recurrence risk by nearly 50%) in the first-line treatment of ovarian cancer, but have no significant improvement in overall survival. It is expected that their recommendation grade in clinical guidelines may be downgraded. However, for the BRCA-mutant population, most patients have definite survival benefits under the premise of controlling adverse reactions.
In the future, the synergistic application of surgery and new drugs will become the key: on the basis of achieving complete cytoreduction or low tumor burden through surgery, combined maintenance therapy with bevacizumab, PARP inhibitors, ADCs and other drugs can maximize the prolongation of patients' overall survival. The core logic of this synergistic model is that surgery creates a "low-tumor-burden environment" for drug therapy, and drug therapy consolidates surgical efficacy or eradicates drug-resistant tumors as early as possible—even for drug-resistant tumors. The two form a dual additive effect, ultimately achieving the maximization of survival benefits.
Summary
2025 has been a fruitful year for ovarian cancer surgery. The record-high survival data from the TRUST study and the China-specific innovations of the SUNNY study have jointly promoted the renewal of surgical treatment concepts. The PET-CT-based PCI scoring system constructed by Chinese experts has provided a "Chinese Standard" for preoperative precision assessment and further improved the standardization level of surgical treatment.
At present, the irreplaceability of surgery in long-term disease-free survival has been clearly confirmed, and standardized quality control and surgical-drug synergy have become the core directions for future development. With the release of the final results of the SUNNY study and more exploratory research on the combination of new drugs and surgery, the multimodal therapy of ovarian cancer will move towards greater precision, efficacy, and safety. In the future, it is necessary to continuously strengthen the integration of clinical research and clinical practice, optimize treatment strategies based on evidence-based data, and bring longer survival and higher quality of life to ovarian cancer patients.
Expert Profile
Professor Zang Rongyu
Zhongshan Hospital Fudan UniversityChief Physician, Professor, Doctoral Supervisor, Director of the Department of Gynecologic Oncology at Zhongshan Hospital Fudan University, Director of the Ovarian Cancer Research Institute of Fudan University
Founding Chair of the Shanghai Gynecologic Oncology Group (SGOG)
Vice Chairperson of the Chinese Society of Gynecologic Oncology (CSGO), Chinese Medical Association
Member of the Board, Asian Society of Gynecologic Oncology (ASGO) (2017–present)
Vice President, Asian Society of Gynecologic Oncology (ASGO) (2026–2027)
Honorary President of the Gynecologic Oncology Branch, Shanghai Medical Doctor Association
Member of the Board of Directors, Gynecologic Cancer InterGroup (GCIG)
President-Elect of the Gynecologic Oncology Branch, Shanghai Medical Association
Responsible Editor: Lily