Survival impact of complete cytoreduction to no gross residual disease for advanced-stage ovarian cancer: A meta-analysis
Survival impact of complete cytoreduction to no gross residual disease for advanced-stage ovarian cancer: A meta-analysis
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DOI：
10.1016/j.ygyno.2013.05.040
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发表时间：
2013-09-01
影响因子：
4.7
通讯作者：
Bristow, Robert E.
中科院分区：
文献类型：
--
作者：
Chang, Suk-Joon;Hodeib, Melissa;Bristow, Robert E.
目标。量化在铂-紫杉烷时代接受治疗的晚期卵巢癌患者完全细胞减少到无肉眼残留病对总生存率的影响。检索PubMed和Cochrane图书馆数据库1996年1月7日至2011年7月7日发表的所有关于晚期卵巢癌细胞减少术的文章。共有18项相关研究(13,257名患者)被确定用于分析。采用一元线性回归和多元线性回归分析，结合加权相关计算，评估临床因素和治疗相关因素对中位生存时间的影响。所有队列的平均加权中位总生存时间为44.4个月(范围27.6-66.9个月)。简单线性回归分析显示，残留病、IV期疾病和使用腹腔化疗与中位生存期显著相关。在多元线性回归分析中控制其他因素后，接受完全细胞减少的患者与无大体残留病变的患者比例每增加10%，队列中位生存期就显著增加2.3月(95%CI=0.64.0，p=0.011)，而最佳细胞减少率(残留病变1 cm)的队列中位生存期增加1.8月(95%CI=0.63.0p=0.004)。接受腹腔化疗的患者比例每增加10%，中位队列生存时间就会显著增加3.9月(95%C_1=1.1-6.8，p=0.008)。对于在铂-紫杉烷时代接受治疗的晚期卵巢癌，无大体残留病变和接受腹膜内化疗的患者比例是与最有利的队列生存时间相关的独立显著因素。(C)2013 Elsevier Inc.保留所有权利。
Objective. To quantify the impact of complete cytoreduction to no gross residual disease on overall survival among patients with advanced-stage ovarian cancer treated during the platinum-taxane era.Methods. PubMed and Cochrane Library databases were searched for all articles on primary cytoreductive surgery for advanced-stage ovarian cancer published from 1/1996 to 7/2011. A total of 18 relevant studies (13,257 patients) were identified for analysis. Simple and multiple linear regression analyses, with weighted correlation calculations, were used to assess the effect on median survival time of clinical and treatment-related factors.Results. The mean weighted median overall survival time for all cohorts was 44.4 months (range, 27.6-66.9 months). Simple linear regression analysis revealed that residual disease, stage IV disease, and use of intraperitoneal chemotherapy were significantly associated with median survival time. After controlling for other factors on multiple linear regression analysis, each 10% increase in the proportion of patients undergoing complete cytoreduction to no gross residual disease was associated with a significant and independent 2.3-month increase (95%Cl = 0.6-4.0, p = 0.011) in cohort median survival compared to a 1.8-month increase (95%Cl = 0.6-3.0, p = 0.004) in cohort median survival for optimal cytoreduction (residual disease 1 cm). Each 10% increase in the proportion of patients receiving intraperitoneal chemotherapy was associated with a significant and independent 3.9-month increase (95%C1 = 1.1-6.8, p = 0.008) in median cohort survival time.Conclusions. For advanced-stage ovarian cancer treated during the platinum-taxane era, the proportions of patients left with no gross residual disease and receiving intraperitoneal chemotherapy are independently significant factors associated with the most favorable cohort survival time. (C) 2013 Elsevier Inc. All rights reserved.