Tumor residual after surgical cytoreduction in prediction of clinical outcome in stage IV epithelial ovarian cancer: A gynecologic oncology group study
Tumor residual after surgical cytoreduction in prediction of clinical outcome in stage IV epithelial ovarian cancer: A gynecologic oncology group study
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DOI：
10.1200/jco.2007.13.1953
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发表时间：
2008-01-01
影响因子：
45.3
通讯作者：
McGuire, William P.
中科院分区：
文献类型：
--
作者：
Winter, William E., III;Maxwell, G. Larry;McGuire, William P.
目的探讨影响IV期卵巢上皮癌患者预后不良的因素。方法对360例国际妇产科联合会IV期上皮性卵巢癌患者的临床资料进行回顾性分析，这些患者接受了6个周期的铂/紫杉醇静脉化疗。结果本组IV期卵巢癌患者的无进展生存期(PFS)和总生存期(OS)的中位数分别为12个月和29个月。多因素回归分析显示，组织学、恶性胸腔积液、实质内肝转移和残留肿瘤大小是显著的预后变量。残留病灶直径0.1~1.0 cm的患者和残留病灶直径1.1~5.0 cm的患者PFS和OS相似。残存大小>5 cm的患者与所有其他组相比，PFS和OS减少。镜下0.1~5.0 cm和>5.0 cm残留病变的中位OS分别为、30和19个月。结论残留病变>5 cm的患者PFS和OS最短，而0.1~1.0 cm和1.1~5.0 cm的患者预后相似。这些发现表明，超放射细胞减少术可能针对那些可以获得微小残留病变的特定患者。最初病程小于5.0厘米且有重大疾病和/或合并症排除显微镜下细胞减少的患者，可考虑作为原发细胞减少以外的替代治疗选择。
Purpose To identify factors predictive of poor prognosis in a similarly treated population of women with stage IV epithelial ovarian cancer (EOC).Patients and Methods A retrospective review of 360 patients with International Federation of Gynecology and Obstetrics stage IV EOC who underwent primary surgery followed by six cycles of intravenous platinum/paclitaxel was performed. A proportional hazards model was used to assess the association of potential prognostic factors with progression-free survival (PFS) and overall survival (OS).Results The median PFS and OS for this group of stage IV ovarian cancer patients was 12 and 29 months, respectively. Multivariate regression analysis revealed that histology, malignant pleural effusion, intraparenchymal liver metastasis, and residual tumor size were significant prognostic variables. Whereas patients with microscopic residual disease had the best outcome, patients with 0.1 to 1.0 cm residual disease and patients with 1.1 to 5.0 cm residual disease had similar PFS and OS. Patients with a residual size more than 5 cm had a diminished PFS and OS when compared with all other groups. Median OS for microscopic, 0.1 to 5.0 cm, and more than 5.0 cm residual disease was 64, 30, and 19 months, respectively.Conclusion Patients with more than 5 cm residual disease have the shortest PFS and OS, whereas patients with 0.1 to 1.0 and 1.1 to 5.0 cm have similar outcome. These findings suggest that ultraradical cytoreductive procedures might be targeted for selected patients in whom microscopic residual disease is achievable. Patients with less than 5.0 cm of disease initially and significant disease and/or comorbidities precluding microscopic cytoreduction may be considered for alternative therapeutic options other than primary cytoreduction.