The Impact of Complete Surgical Staging Upon Survival in Early-Stage Ovarian Clear Cell Carcinoma A Multi-institutional Retrospective Study
The Impact of Complete Surgical Staging Upon Survival in Early-Stage Ovarian Clear Cell Carcinoma A Multi-institutional Retrospective Study
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DOI：
10.1111/igc.0b013e3181a83f4f
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发表时间：
2009-11-01
影响因子：
4.8
通讯作者：
Kikuchi, Yoshihiro
中科院分区：
文献类型：
--
作者：
Takano, Masashi;Sugiyama, Toru;Kikuchi, Yoshihiro
纯型透明细胞癌（Pure-type clear cell carcinoma， CCC）是卵巢癌的一个独特亚型，对传统铂类化疗具有耐药性，预后较差。该研究的目的是通过多机构回顾性分析来评估早期CCC患者完全手术分期的效果。在1992年至2002年期间，共发现199例pT1 M0型CCC患者。生存分析采用Kaplan-Meier法估计，预后因素采用Cox回归模型评估。在pT1型MO肿瘤中，125例（pN0, 63%）腹膜后淋巴结状态为阴性，10例（pN1, 5%）腹膜后淋巴结状态为阳性，64例（pNx, 32%）腹膜后淋巴结状态未知。pN1的无进展生存期明显低于pN0 (P < 0.05)，而pN1与pNx的无进展生存期差异无统计学意义。三组患者总生存期（OS）比较，差异无统计学意义。多因素分析显示，腹膜细胞学状态是无进展生存的唯一独立预后因素（P = 0.04），但手术分期程序的完成并不是预后因素。OS无明显预后因素。我们的研究表明，完整的手术分期使我们能够区分pT1 MO CCC复发的高危组；然而，该过程不能改善操作系统。虽然该研究是一项有限的回顾性研究，但腹膜细胞学状态的影响比完全手术分期对CCC患者的影响更重要。更有效的治疗方式是必要的，特别是对于恶性腹膜细胞学阳性的CCC病例。
Pure-type clear cell carcinoma (CCC) has been recognized as a distinct subtype of ovarian cancer, showing resistance to conventional platinum-based chemotherapy and resulting in poor prognosis. The aim of the study was to evaluate the effects of complete surgical staging procedures for early-stage CCC patients in a retrospective multi-institutional analysis. During the period 1992 to 2002, a total of 199 patients with pT1 M0 CCC were identified. Survival analysis was estimated by Kaplan-Meier methods, and prognostic factors were evaluated using a Cox regression model. Among pT1 MO tumors, retroperitoneal lymph node status was negative in 125 cases (pN0, 63%), positive in 10 cases (pN1, 5%), and unknown in 64 cases (pNx, 32%). Progression-free survival of pN1 was significantly worse than that of pN0 (P < 0.05), whereas there was no significant difference between pN1 and pNx. There was no significant difference of overall survival (OS) among the 3 groups. Multivariate analysis revealed that peritoneal cytology status was the only independent prognostic factor for progression-free survival (P = 0.04), but completion of surgical staging procedures was not a prognostic factor. There was no significant prognostic factor for OS. Our study implied that complete surgical staging enabled us to distinguish a high-risk group of recurrence in pT1 MO CCC; however, the procedure could not improve OS. Although the study was a limited retrospective study, the impact of peritoneal cytology status was more important than complete surgical staging procedure in CCC patients. More effective treatment modality was warranted, especially for CCC cases positive for malignant peritoneal cytology.