Primary Versus Interval Debulking Surgery in Advanced Ovarian Cancer Results From a Systematic Single-Center Analysis
Primary Versus Interval Debulking Surgery in Advanced Ovarian Cancer Results From a Systematic Single-Center Analysis
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DOI：
10.1111/igc.0b013e3181f15714
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发表时间：
2010-11-01
影响因子：
4.8
通讯作者：
Fotopoulou, Christina
中科院分区：
文献类型：
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作者：
Sehouli, Jalid;Savvatis, Konstantinos;Fotopoulou, Christina
目的：评估原发性晚期卵巢癌（AOC）患者接受最佳原发性肿瘤减积手术（PDS）与间隔减积手术（IDS）后手术和临床结局的差异。方法：根据发病率定义的肿瘤扩散模式和手术结局，无进展（PFS）生存期和总生存期（OS）对2000年9月至2009年8月在我院接受手术的AOC患者进行了系统分析。采用Kaplan-Meier曲线计算总生存期和PFS。单变量和考克斯回归分析进行，以确定IDS对手术结果和survival.Results的影响：总体而言，372例连续患者与组织学证实AOC（FIGO [国际妇产科联合会]阶段III/IV）进行了评价。40例患者（10.8%）在中位5个周期（范围，2-6个周期）铂类和紫杉烷类化疗后接受IDS，332例患者（89.2%）接受PDS。与PDS患者相比，IDS患者的下腹部（78.9% vs 98.8%; P < 0.001）和中腹部（68.4% vs 83.1%; P = 0.044）肿瘤累及率显著降低。在IDS期间，手术并发症发生率（36.4% vs 36.5%; P = 1.00）与PDS（85% vs 58.7%; P = 0.02）相比，完全切除肿瘤的概率显著更高。然而，IDS患者的平均PFS显着降低（14.6 vs 33.2个月; P < 0.001）。PDS患者的平均OS也较高，但仅在肿瘤完全切除时才达到统计学显著性（65.4 vs 37.9个月; P = 0.005）。多变量分析表明，IDS与一个不利的OS和PFS。结论：它似乎是PDS有一个更有利的结果比IDS的OS和PFS在AOC患者，即使IDS导致显着更高的肿瘤完全切除率。
Objective: To evaluate the difference in operative and clinical outcome for patients with primary advanced ovarian cancer (AOC) after optimal primary debulking surgery (PDS) versus interval debulking surgery (IDS).Methods: Tumor dissemination pattern and surgical outcome, as defined by morbidity, progression-free (PFS) survival and overall survival (OS) were systematically analyzed in AOC patients who underwent surgery in our institution between September 2000 and August 2009. Overall survival and PFS were calculated by Kaplan-Meier curves. Univariate and Cox regression analysis were performed to identify the impact of IDS on surgical outcome and survival.Results: Overall, 372 consecutive patients with histologically proven AOC (FIGO [International Federation of Gynecology and Obstetrics] stage III/IV) were evaluated. Forty patients (10.8%) underwent IDS after a median of 5 cycles (range, 2-6 cycles) platinum- and taxane-based chemotherapy, and 332 patients (89.2%) underwent PDS. Patients who underwent IDS had a significantly lower rate of tumor involvement of the lower (78.9% vs 98.8%; P < 0.001) and middle abdomen (68.4% vs 83.1%; P = 0.044) compared with PDS patients. During IDS, a significantly higher probability for complete tumor resection occurred when compared with PDS (85% vs 58.7%; P = 0.02) by equivalent rates of operative complications (36.4% vs 36.5%; P = 1.00). However, mean PFS was significantly reduced in IDS patients (14.6 vs 33.2 months; P < 0.001). Mean OS was also higher in PDS patients, but this reached a statistical significance only when complete tumor resection was obtained (65.4 vs 37.9 months; P = 0.005). Multivariate analysis identified that IDS was associated with an unfavorable OS and PFS.Conclusions: It seems that PDS has a more favorable outcome than IDS on both OS and PFS in AOC patients, even though IDS leads to significantly higher rates of complete tumor resection.