Complete cytoreductive surgery is feasible and maximizes survival in patients with advanced epithelial ovarian cancer: A prospective study
Complete cytoreductive surgery is feasible and maximizes survival in patients with advanced epithelial ovarian cancer: A prospective study
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DOI：
10.1006/gyno.1998.4955
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发表时间：
1998-05-01
影响因子：
4.7
通讯作者：
Wang, HJ
中科院分区：
文献类型：
--
作者：
Eisenkop, SM;Friedman, RL;Wang, HJ
目标。尽管手术细胞减灭术的完成性与晚期卵巢癌患者的存活率相关，但相对较少的患者进行了完全的细胞减灭术。这项研究旨在前瞻性地确定IIIC和IV期卵巢上皮癌患者通过手术消除所有可见疾病的能力及其对生存的相关影响。在1990至1996年间，连续163名患者接受了原发细胞减少术。目标是在以铂为基础的全身联合化疗开始之前，切除或消融所有可见的疾病。多变量分析确定了哪些临床和病理变量影响细胞完全减少(Logistic回归)和生存率(Cox比例风险模型)。139例(85.3%)肿瘤全部切除，22例(13.5%)肿瘤细胞减少至小于或等于1 cm残留病变，2例(1.2%)肿瘤未切除。整个队列的中位生存期和估计的5年生存率分别为54个月和48%。达到完全细胞减少的可能性独立于妇科肿瘤组的术前状态(0-1比2-3，P=0.005)、肠系膜和肠浆膜植入的数量(小于或等于75比75，P=0.005)和分期(IIIC比IV，P=0.006)。年龄(小于或等于61岁，P=0.003.0 1)、腹水量(小于或等于1升，P=0.0 1)、分期(IIIC与IV期，P=0.0 4)、组织学(透明细胞和粘液与所有其他类型，P=0.0 3)、细胞减灭术的完全性(完全与不完全细胞减少性，P=0.0 2)是影响患者生存的独立因素。对于大多数患者来说，完全的细胞减少是可能的，并提高了存活率，即使与残留病变最少(小于或等于1厘米)的手术相比也是如此。除非他们的身体状况禁止麻醉和手术，否则晚期上皮性卵巢癌患者应该接受一次细胞减少术，以期完全切除肿瘤。(C)1998年学术出版社。
Objective. Despite correlation between the completeness of surgical cytoreduction and survival for patients with advanced ovarian cancer, relatively few undergo complete cytoreduction. This study was initiated to prospectively determine the ability to surgically eliminate all visible disease in patients with stage IIIC and IV epithelial ovarian cancer and the associated impact on survival.Methods. Between 1990 and 1996, 163 consecutive patients underwent primary cytoreduction. The goal was the excision or ablation of all visible disease prior to initiation of systemic platinum-based combination chemotherapy. A multivariate analysis determined which clinical and pathologic variables influenced the probability of achieving complete cytoreduction (logistic regression) and survival (Cox proportional hazards model).Results. One hundred thirty-nine patients (85.3%) underwent removal of all visible tumor, 22 (13.5%) had cytoreduction to less than or equal to 1 cm residual disease, and 2 (1.2%) had unresected bulky disease. The median and estimated 5-year survival for the entire cohort was 54 months and 48%, respectively. The probability of achieving complete cytoreduction was influenced independently by the preoperative Gynecologic Oncology Group performance status (0-1 vs 2-3, P = 0.04), the number of mesenteric and intestinal serosal implants (less than or equal to 75 vs >75 implants, P = 0.005), and stage (IIIC vs IV, P = 0.006). The probability of survival was independently influenced by age (less than or equal to 61 vs >61 years, P = 0.003), volume of ascites (less than or equal to 1 vs >1 liter, P = 0.01), stage (IIIC vs IV, P = 0.04), histology (clear cell and mucinous vs all other, P = 0.03), and the completeness of cytoreductive operation (complete vs incomplete cytoreduction, P = 0.02).Conclusions. Complete cytoreduction is possible for the majority of patients and improves survival, even compared to operations with minimal (less than or equal to 1 cm) residual disease. Unless their medical condition prohibits anesthesia and surgery, patients with advanced epithelial ovarian cancer should undergo primary cytoreductive surgery with the intention of complete tumor removal. (C) 1998 Academic Press.