Survival impact of surgical cytoreduction in stage IV epithelial ovarian cancer
Survival impact of surgical cytoreduction in stage IV epithelial ovarian cancer
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DOI：
10.1006/gyno.1998.5145
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发表时间：
1999-03-01
影响因子：
4.7
通讯作者：
Karlan, BY
中科院分区：
文献类型：
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作者：
Bristow, RE;Montz, FJ;Karlan, BY
Objective.本研究的目的是评估手术减瘤对IV期卵巢上皮癌患者生存率的影响，并确定减瘤肝外疾病对肝转移患者亚组生存率的影响。回顾性审查了所有在1982年1月1日至1994年12月31日期间接受国际妇产科联合会IV期卵巢癌治疗的妇女的病历。提取的临床信息包括诊断时的年龄、体力状态、组织学亚型、肿瘤分级、IV期标准、腹水量、主要腹膜肿瘤类型、进行的外科手术、肝肿瘤残留、肝外肿瘤残留和术后并发症。最佳手术状态定义为残留病灶sl cm。记录化疗治疗和随访情况。使用Kaplan-Meier方法和对数秩检验进行生存分析和比较。采用考克斯比例风险回归模型确定与生存率提高相关的独立变量。有84名女性患有IV期卵巢癌，并提供了完整的手术和术后信息。诊断时的中位年龄为61岁（范围26-85岁）。83%的患者（70/84）的体能状态小于或等于2。在44/84例患者（52%）中发现乳头状浆液性组织学，55例患者（65%）有3级肿瘤。84例患者中37例（44%）有肝实质转移，32/84例（38%）有恶性胸腔积液。总体中位生存期为18.1个月，与体力状态（P = 0.002）、主要腹膜肿瘤类型（P = 0.0002）和接受的化疗方案数量（P = 0.0039）高度相关。在所有患者中尝试了初次手术细胞减灭术，25/84（30%）达到了最佳状态。最佳细胞减少患者的中位生存期为38.4个月，而次佳残留病变患者的中位生存期为10.3个月（P = 0.0004）。在肝转移患者中，46%（17/37）的患者获得了最佳的肝外细胞减灭。37例患者中有6例（16%）接受了肝外和肝脏疾病的最佳切除，中位生存期为50.1个月，而11例（30%）肝外疾病最佳但肝脏肿瘤残留不佳的患者中位生存期为27.0个月。20例患者（54%）留下了次优残留肝外和肝脏疾病，中位生存期为7.6个月（P = 0.0001）。在多变量分析中，最佳减瘤手术和体能状态作为生存的独立预测因素仍然具有重要意义。最佳的手术减积和性能状态似乎是IV期上皮性卵巢癌患者生存的重要决定因素。即使在不可切除的肝转移患者中，肝外疾病的最佳减积也与显著的生存优势相关，（C）1999年学术出版社。
Objective. The aim of this study was to evaluate the influence of surgical cytoreduction on survival in patients with Stage IV epithelial ovarian cancer and to determine the survival impact of debulking extrahepatic disease in the subgroup of patients with liver metastasis.Methods. Medical records were retrospectively reviewed for all women with International Federation of Gynecology and Obstetrics Stage IV ovarian cancer treated between 1/1/82 and 12/31/94. Clinical information abstracted included age at diagnosis, performance status, histologic subtype, tumor grade, Stage IV criteria, ascites volume, predominant peritoneal tumor pattern, surgical procedures performed, hepatic tumor residuum, extrahepatic tumor residuum, and postoperative complications. Optimal surgical status was defined as residual disease sl cm. Chemotherapy treatment and follow-up were recorded. Survival analysis and comparisons were performed using the Kaplan-Meier method and the log-rank test. The Cox proportional hazards regression model was used to identify independent variables associated with an improved survival rate.Results. There were 84 women with Stage IV ovarian cancer and complete operative and postoperative information available. Median age at diagnosis was 61 years (range 26-85 years). Performance status was less than or equal to 2 in 83% of patients (70/84). Papillary serous histology was found in 44/84 patients (52%) and 55 patients (65%) had grade 3 tumors. Thirty-seven of 84 patients (44%) had parenchymal liver metastasis and 32/84 (38%) had malignant pleural effusion. Overall median survival was 18.1 months and was highly correlated with performance status (P = 0.002), predominant peritoneal tumor pattern (P = 0.0002), and the number of chemotherapy regimens received (P = 0.0039). Primary surgical cytoreduction was attempted in all patients and 25/84 (30%) achieved optimal status. Median survival of optimally cytoreduced patients was 38.4 months, compared to 10.3 months for patients with suboptimal residual disease (P = 0.0004). In patients with liver metastasis, optimal extrahepatic cytoreduction was achieved in 46% (17/37). Six of 37 patients (16%) underwent optimal resection of both extrahepatic and hepatic disease and had a median survival of 50.1 months, compared to a median survival of 27.0 months for the 11 patients (30%) with optimal extrahepatic dis-ease but suboptimal residual hepatic tumor. Twenty patients (54%) were left with both suboptimal residual extrahepatic and hepatic disease and had a median survival of 7.6 months (P = 0.0001). Optimal debulking surgery and performance status retained significance as independent predictors of survival on multivariate analysis.Conclusions. Optimal surgical debulking and performance status appear to be important determinants of survival in patients with Stage IV epithelial ovarian cancer. Even in patients with unresectable liver metastasis, optimal debulking of extrahepatic disease is associated with a significant survival advantage, (C) 1999 Academic Press.