Clinical Outcome of Tertiary Surgical Cytoreduction in Patients with Recurrent Epithelial Ovarian Cancer
Clinical Outcome of Tertiary Surgical Cytoreduction in Patients with Recurrent Epithelial Ovarian Cancer
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DOI：
10.1245/s10434-010-1245-3
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发表时间：
2011-01-01
影响因子：
3.7
通讯作者：
Sehouli, Jalid
中科院分区：
文献类型：
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作者：
Fotopoulou, Christina;Richter, Rolf;Sehouli, Jalid
背景第三次细胞减灭术（TCS）对复发性上皮性卵巢癌（ROC）患者总生存期（OS）的价值尚未明确。本研究的目的是评估TCS后的手术和临床结果。我们系统地评价了所有接受TCS的连续患者。肿瘤扩散模式，手术发病率，残留肿瘤和生存率的基础上，一个有效的术中文件工具进行了描述。用考克斯回归或逻辑回归模型分析生存和肿瘤完全切除的预测因素。在2000年10月至2008年12月期间，对135例（中位年龄51岁;范围22-80岁）主要为初始FIGO分期>= III期（106例患者，78.5%）的患者进行了评价。在53例患者（39.3%）中，获得了完整的肿瘤切除。1个月手术死亡率为6%。在中位9.6个月（范围0.1-75个月）的随访期间，78例患者（57.8%）死亡，52例患者（38.5%）进一步复发。总体的中位OS为19.1个月（95%置信区间[95% CI]，14.84-23.35）。无残留肿瘤患者的中位OS为37.8个月（95% CI，12.7-62.7）;而残留肿瘤<1 cm的患者为19.0个月（95% CI，9.8-28.2）（P <0.001）。腹膜癌转移的存在似乎对OS没有显著影响。肿瘤完全切除被确定为OS的最强预测因子。OS的其他独立预测因子为首次诊断间隔≥ 3年（风险比[HR]，0.28; 95%CI，0.14-0.59）和浆液性乳头状组织学（HR，0.23; 95%CI，0.09-0.56）。共有42例患者（31.1%）出现至少1例重大并发症。多变量分析表明肿瘤累及中腹部和腹膜癌转移是肿瘤完全切除的独立预测因素。即使在TCS情况下，术后肿瘤残留疾病仍然是生存率的最强预测因素。为了确定TCS的最佳候选者，腹水和腹膜癌转移的预测价值应该通过未来的前瞻性试验来证实。
Background. The value of tertiary cytoreductive surgery (TCS) on overall survival (OS) of patients with relapsed epithelial ovarian cancer (ROC) is not well defined. Aim of the present study was to evaluate the operative and clinical outcome after TCS.Methods. We systematically evaluated all consecutive patients undergoing TCS. Tumor dissemination pattern, operative morbidity, residual tumor, and survival are described based on a validated intraoperative documentation tool. Predictors of survival and complete tumor resection are analyzed with Cox regression or logistic regression models.Results. Between October 2000 and December 2008, 135 patients (median age, 51 years; range, 22-80 years) of mainly initial FIGO stage >= III (106 patients, 78.5%) were evaluated. In 53 patients (39.3%) a complete tumor-resection was obtained. The 1-month operative mortality was 6%. During a median follow-up period of 9.6 months (range, 0.1-75 months), 78 patients (57.8%) died, while 52 patients (38.5%) experienced a further relapse. Median OS was 19.1 months for the total collective (95% confidence interval [95% CI], 14.84-23.35). Median OS was 37.8 months (95% CI, 12.7-62.7) for patients without residual tumor; versus 19.0 months (95% CI, 9.8-28.2) for residual tumor 1 cm (P < .001). The presence of peritoneal carcinomatosis did not seem to significantly affect OS. Complete tumor resection was identified as the strongest predictor of OS. Other independent predictors of OS were interval to primary diagnosis >= 3 years (hazard ratio [HR], 0.28; 95% CI, 0.14-0.59) and serous papillary histology (HR, 0.23; 95% Cl, 0.09-0.56). A total of 42 patients (31.1%) presented at least 1 major complication. Multivariate analysis identified tumor involvement of the middle abdomen and peritoneal carcinomatosis as independent predictors of complete tumor resection.Conclusions. Postoperative tumor residual disease remains the strongest predictor of survival even in TCS setting. To identify the optimal candidates for TCS, the predictive value of ascites and peritoneal carcinomatosis should be confirmed by future prospective trials.