Analysis of failures after negative second-look in patients with advanced ovarian cancer: An Italian multicenter study
Analysis of failures after negative second-look in patients with advanced ovarian cancer: An Italian multicenter study
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DOI：
10.1006/gyno.1997.4890
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发表时间：
1998-02-01
影响因子：
4.7
通讯作者：
Cristofani, R
中科院分区：
文献类型：
--
作者：
Gadducci, A;Sartori, E;Cristofani, R
这项多中心回顾性研究基于192例在二次探查手术中病理完全缓解的晚期卵巢癌患者。94名（48.9%）患者在手术重新评估后中位18个月（范围，4-89个月）后出现疾病复发。盆腔复发45例（47.9%），腹部复发42例（44.7%），腹膜后淋巴结复发13例（13.8%），远处复发20例（21.2%）。在整个系列中，阴性二次检查后的5年和7年无病生存率分别为47.4%和44.5%。经对数秩检验，无病生存率与FIGO分期（P = 0.008）、肿瘤分级（P = 0.0021）、初次手术后残留病灶大小（P = 0.0038）和二次探查类型（腹腔镜与开腹手术，P = 0.0061）有关，但与组织学类型和一线化疗无关。考克斯比例风险模型显示肿瘤分级、残留病灶大小和二次随访类型是无病生存的独立预后变量。与1级疾病相比，2级和3级疾病的复发风险比分别为2.386（95% CI，1.140-4.990）和3.118（95% CI，1.515-6.416）。与残留病变< 1 cm的患者相比，残留病变1-2 cm和> 2 cm的患者的风险比分别为1.877（95% CI，1.117-3.156）和2.156（95% CI，1.324-3.511）。与接受剖腹再评估的患者相比，接受腹腔镜二次探查的患者的风险比为1.826（95% CI，1.121-2.973）。初次手术后分化差的分级和大的残留病灶是阴性二次检查后复发的最强预后变量。(C)北京：科学出版社.
This multicenter retrospective study is based on 192 patients with advanced ovarian cancer in pathological complete response at second-look surgery. Ninety-four (48.9%) patients developed recurrent disease after a median time of 18 months (range, 4-89 months) from surgical reassessment. The recurrence involved the pelvis in 45 (47.9%) cases, the abdomen in 42 (44.7%), the retroperitoneal lymph nodes in 13 (13.8%), and distant sites in 20 (21.2%). On the whole series, 5- and 7-year disease-free survival rates after negative second-look were 47.4 and 44.5%, respectively. By log-rank test the disease-free survival rate was related to FIGO stage (P = 0.008), tumor grade (P = 0.0021), size of residual disease after initial surgery (P = 0.0038), and type of second-look (laparoscopy vs laparotomy, P = 0.0061), but not to histological type and first-line chemotherapy. Cox proportional hazard model showed that tumor grade, size of residual disease, and type of second-look were independent prognostic variables for disease-free survival. The risk ratio of relapse was 2.386 (95% CI, 1.140-4.990) for grade 2 and 3.118 (95% CI, 1.515-6.416) for grade 3 compared to grade 1 disease. For patients with residual disease 1-2 cm and > 2 cm the risk ratio was, respectively, 1.877 (95% CI, 1.117-3.156) and 2.156 (95% CI, 1.324-3.511) compared to patients with residual disease < 1 cm. The risk ratio was 1.826 (95% CI, 1.121-2.973) for patients who were submitted to a laparoscopic second-look compared to those who underwent a laparotomic reassessment. Poorly differentiated grade and large residual disease after initial surgery are the strongest prognostic variables for recurrence after a negative second-look. (C) 1998 Academic Press.