Identification of patient groups at highest risk from traditional approach to ovarian cancer treatment
Identification of patient groups at highest risk from traditional approach to ovarian cancer treatment
复制标题
DOI：
10.1016/j.ygyno.2010.09.010
复制
发表时间：
2011-01-01
影响因子：
4.7
通讯作者：
Cliby, William A.
中科院分区：
文献类型：
--
作者：
Aletti, Giovanni D.;Eisenhauer, Eric L.;Cliby, William A.
目标。确定晚期卵巢癌（AOC）患者在传统的最大手术加化疗后主要发病和死亡风险最高的亚组。对来自4个中心的连续原发性AOC患者的术前健康、术中发现和结局进行评估。根据肿瘤的体积将初始肿瘤播散分为3组。使用先前描述的手术复杂性评分（SCS）对手术进行分类。统计分析旨在验证多变量风险调整模型。分析了576例IIIC （N = 447, 77.6%）或IV期AOC （N = 129, 22.4%）患者。年龄(HR（年）：1.02；95%CI: 1.01-1.03)、高肿瘤播散（HTD） （HR: 1.73; 95%CI: 1.19-2.56）、残留病变(RD) >1 cm （HR: 2.46; 95%CI: 1.74-3.53）、IV期（HR: 1.93; 95%CI: 1.51-2.45）与OS独立相关。我们确定了一个由高风险组（N = 38, 6.6%）组成的小亚组患者，其特征包括以下所有特征：高初始肿瘤播散（HTD）或IV期，加上不良的表现或营养状况，加上年龄>= 75。在该组中，高SCS达到低RD的发病率为63.6%，生存获益有限。AOC的最佳管理需要准确的、经风险调整的预测结果，以便从初级治疗开始采用量身定制的方法。复杂的外科手术可以降低RD，提高生存率，在大多数情况下，这种手术的好处似乎超过了发病率。然而，仔细的分析确定了一个亚组患者的替代方法可能是更好的策略。(C) 2010爱思唯尔公司版权所有。
Objective. Define subgroups of patients at highest risk for major morbidity and mortality after a traditional approach of maximal surgical efforts followed by chemotherapy for advanced ovarian cancer (AOC).Methods. Preoperative health, intra-operative findings and outcomes were assessed in consecutive patients with primary AOC from 4 centers. Initial tumor dissemination was stratified into 3 groups based on volume of disease. Surgery was categorized using a previously described surgical complexity score (SCS). Statistical analysis was directed toward validating a multivariable risk-adjusted model.Results. 576 patients with stage IIIC (N = 447, 77.6%) or IV AOC (N = 129, 22.4%) were analyzed. Age (HR (per year): 1.02; 95%CI: 1.01-1.03), high tumor dissemination (HTD) (HR: 1.73; 95%CI: 1.19-2.56), residual disease (RD) >1 cm (HR: 2.46; 95%CI: 1.74-3.53), and stage IV (HR: 1.93; 95%CI: 1.51-2.45), independently correlated with OS. We identified a small subgroup of patients who comprised a high-risk group (N = 38, 6.6%) characterized by all of the following characteristics: high initial tumor dissemination (HTD) or stage IV plus poor performance or nutritional status plus age >= 75. In this group, high SCS to achieve low RD was associated with morbidity of 63.6% and limited survival benefit.Conclusions. Optimal management of AOC requires accurate, risk-adjusted predictors of outcomes allowing a tailored approach starting with primary therapy. Complex surgical procedures to render low RD improve survival, and in the majority of cases, the benefits of such surgery appear to outweigh the morbidity. However careful analysis identifies a subgroup of patients in whom an alternative approach may be the better strategy. (C) 2010 Elsevier Inc. All rights reserved.