Overall Survival Following Neoadjuvant Chemotherapy vs Primary Cytoreductive Surgery in Women With Epithelial Ovarian Cancer: Analysis of the National Cancer Database.
Overall Survival Following Neoadjuvant Chemotherapy vs Primary Cytoreductive Surgery in Women With Epithelial Ovarian Cancer: Analysis of the National Cancer Database.
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DOI：
10.1001/jamaoncol.2016.4411
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发表时间：
2017-01-01
期刊：
影响因子：
28.4
通讯作者：
Keating NL
中科院分区：
文献类型：
--
作者：
Rauh-Hain JA;Melamed A;Wright A;Gockley A;Clemmer JT;Schorge JO;Del Carmen MG;Keating NL
原发性细胞减少手术（PCS）与新辅助化疗（NACT）治疗晚期上皮性卵巢癌（EOC）的相对益处仍然存在不确定性。比较PCS和NACT在全国大量晚期EOC妇女中的总生存率。回顾性队列研究。美国各地的医院向国家癌症数据库报告了2003-2011年期间治疗晚期EOC患者的情况。我们确定了2003-2011年间诊断为IIIC和IV期EOC的女性。我们关注年龄≤70岁且Charlson合并症指数=0的患者，他们可能是两种治疗的候选人。PCS与NACT的初始治疗方法，使用意向治疗分析进行检验。总生存期，定义为从癌症诊断到死亡或最后一次接触的时间。我们使用倾向评分匹配来比较接受PCS和NACT的相似女性。采用Kaplan-Meier法和log-rank检验评估治疗方法与总生存率的相关性。我们评估了研究结果是否受到未观察到的混杂因素患病率差异的影响，如有限的表现状态[东部肿瘤合作组（ECOG） 1-2]、术前疾病负担和BRCA状态。在22,962例患者中，19,836例（86.4%）接受了PCS， 3,126例（13.6%）接受了NACT。我们将2935名接受NACT治疗的患者与接受PCS治疗的相似患者进行了配对。在倾向评分匹配组中，PCS组的中位总生存期为37.3 （95% CI, 35.2-38.7）个月，NACT组的中位总生存期为32.1 （95% CI, 30.8-34.1）个月（P<0.001）。然而，与PCS相比，如果NACT组中表现为1-2的女性比例更高（60% vs 50%），则PCS与生存率的提高之间的关联不具有统计学意义。在≤70岁的健康女性中，与NACT相比，PCS与生存率提高相关。接受NACT治疗的女性生存率较低，可能是由于在接受NACT治疗的女性中，表现受限的比例较高。
Uncertainty remains about the relative benefits of primary cytoreductive surgery (PCS) versus neoadjuvant chemotherapy (NACT) for advanced-stage epithelial ovarian cancer (EOC). Compare overall survival of PCS versus NACT in a large national population of women with advanced-stage EOC. Retrospective cohort study. Hospitals across the United States reporting to the National Cancer Data Base who cared for patients with advanced-stage EOC diagnosed between 2003–2011. We identified women with stage IIIC and IV EOC diagnosed between 2003–2011. We focused on patients aged ≤70 years with a Charlson comorbidity index=0 who were likely candidates for either treatment. Initial treatment approach of PCS vs. NACT, examined using an intent-to-treat analysis. Overall survival, defined as months from cancer diagnosis to death or date of the last contact. We used propensity score matching to compare similar women who underwent PCS and NACT. The association of treatment approach with overall survival was assessed using the Kaplan-Meier method and the log-rank test. We assessed whether the findings were influenced by differences in the prevalence of an unobserved confounder, such as limited performance status [Eastern Cooperative Oncology Group (ECOG) 1–2], pre-operative disease burden, and BRCA status. Among 22,962 patients, 19,836 (86.4%) received PCS and 3,126 (13.6%) underwent NACT. We matched 2,935 patients treated with NACT with similar patients who received PCS. Among propensity-score matched groups, the median overall survival was 37.3 (95% CI, 35.2–38.7) months in the PCS group and 32.1 (95% CI, 30.8–34.1) months in the NACT group (P<0.001). However, if the NACT group had a higher proportion of women with performance statuses of 1–2 compared with PCS (60% vs. 50%), the association of PCS and improved survival would not be statistically significant. PCS was associated with improved survival compared with NACT in healthy women aged ≤70 years. The lower survival in women who received NACT could be explained by a higher prevalence of limited performance status in women undergoing NACT.
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DOI：
10.1016/j.jamcollsurg.2012.12.016
发表时间：
2013-03-01
影响因子：
5.2
作者：
Mallin, Katherine;Palis, Bryan E.;Edge, Stephen B.
通讯作者：
Edge, Stephen B.
影响因子：
4.7
作者：
Chi, Dennis S.;Eisenhauer, Eric L.;Barakat, Richard R.
通讯作者：
Barakat, Richard R.
影响因子：
4.7
作者：
Dewdney, Summer B.;Rimel, B. J.;Zighelboim, Israel
通讯作者：
Zighelboim, Israel
影响因子：
7.2
作者：
Klabunde, CN;Potosky, AL;Warren, JL
通讯作者：
Warren, JL
DOI：
10.1097/igc.0b013e31823ea1d8
发表时间：
2012-03-01
影响因子：
4.8
作者：
Cornelis, Sarah;Van Calster, Ben;Vergote, Ignace
通讯作者：
Vergote, Ignace