Improved progression-free and overall survival in advanced ovarian cancer as a result of a change in surgical paradigm
Improved progression-free and overall survival in advanced ovarian cancer as a result of a change in surgical paradigm
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DOI：
10.1016/j.ygyno.2009.03.018
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发表时间：
2009-07-01
影响因子：
4.7
通讯作者：
Barakat, Richard R.
中科院分区：
文献类型：
--
作者：
Chi, Dennis S.;Eisenhauer, Eric L.;Barakat, Richard R.
目标。目的：确定晚期上皮性卵巢癌手术方式的程序性改变对无进展生存率(PFS)和总体生存率(OS)的影响。对两组IIIC和IV期卵巢、输卵管和腹膜癌患者进行了比较。第1组为对照组，从1/96~12/99行原发细胞减少术的168例患者。第二组为研究组，从1/01-12/04年1月12日接受一次手术的210例患者组成，在此期间对上腹部疾病进行了更全面的剥离。两组在年龄、原发部位、手术分期、肿瘤分级、美国麻醉医师学会分级、术前血清CA-125和血小板水平、腹水百分比或腹水量、最大肿块大小或位置、术后化疗类型等方面均无差异。2组患者较1组患者更常见的是广泛的上腹部手术(S，分别为38%和0%；P<；0.001)和细胞减少到残留病变1厘米(分别为80%和46%，P<；0.01)。2组患者5年PFS和OS发生率分别为31%和14%(风险比，0.757；95%CI，0.601~0.953；P=0.01)；5年OS率分别为47%和35%(HR，0.764；95%CI，0.592~0.987；P=0.03)。合并广泛的上腹部手术可提高最佳细胞减少率，显著改善PFS和OS。向更彻底的原发细胞减灭术转变可以提高晚期卵巢癌、输卵管癌和腹膜癌患者的生存率。(C)2009 Elsevier Inc.保留所有权利。
Objective. To determine the impact on progression-free survival (PFS) and overall survival (OS) of a programmatic change in surgical approach to advanced epithelial ovarian cancer.Methods. Two groups of patients with stage IIIC and IV ovarian, tubal, and peritoneal carcinoma were compared. Group 1, the control group, consisted of all 168 patients who underwent primary cytoreduction from 1/96 to 12/99. Group 2, the study group, consisted of all 210 patients who underwent primary surgery from 1/01 to 12/04, during which time a more comprehensive debulking of upper abdominal disease was utilized.Results. There were no differences between the groups in age, primary site of disease, surgical stage, tumor grade, American Society of Anesthesiologists class, preoperative serum CA-125 and platelet levels, percentage with or amount of ascites, size or location of largest tumor mass, or type of postoperative chemotherapy. Patients in Group 2 vs Group 1 more frequently had extensive upper abdominal procedure(s) (38% vs 0%, respectively; P < 0.001) and cytoreduction to residual disease < 1 cm (80% vs 46%, respectively; P < 0.01). Five-year PFS and OS rates were significantly improved in Group 2. For Group 2 vs Group 1 patients, 5-year PFS rates were 31% vs 14%, respectively (hazard ratio, 0.757; 95% Cl, 0.601-0.953; P = 0.01]; and 5-year OS rates were 47% vs 35%, respectively (HR, 0.764; 95% CI, 0.592-0.987; P = 0.03].Conclusion. The incorporation of extensive upper abdominal procedures resulted in increased optimal cytoreduction rates and significantly improved PFS and OS. A paradigm shift toward more complete primary cytoreduction can improve survival for patients with advanced ovarian, tubal, and peritoneal carcinomas. (C) 2009 Elsevier Inc. All rights reserved.