Primary cytoreductive surgery and adjuvant hormonal monotherapy in women with advanced low-grade serous ovarian carcinoma: Reducing overtreatment without compromising survival?
Primary cytoreductive surgery and adjuvant hormonal monotherapy in women with advanced low-grade serous ovarian carcinoma: Reducing overtreatment without compromising survival?
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DOI：
10.1016/j.ygyno.2017.07.127
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发表时间：
2017-10-01
影响因子：
4.7
通讯作者：
Rose, Peter G.
中科院分区：
文献类型：
--
作者：
Fader, Amanda N.;Bergstrom, Jennifer;Rose, Peter G.
目标.晚期、低级别浆液性卵巢癌（LGSC）患者化疗反应率低，总体生存率低。大多数LGSC肿瘤过度表达激素受体，这是一个潜在的治疗靶点。我们的研究目的是确定晚期LGSC患者接受原发性肿瘤细胞减灭术（CRS）和激素治疗（HT）的结果。在两个学术癌症中心进行了一项回顾性研究。II-IV期LGSC患者在2004年至2016年期间接受了原发性或间歇性CRS，随后接受了辅助性HT。妇科病理学家审查了所有病例。计算2年无进展生存期（PFS）和总生存期（OS）。研究了27例患者; 26例患者接受了原发性CRS，随后接受了HT，而1例患者接受了新辅助化疗，随后接受了CRS和HT。患者的中位年龄为47.5岁，患者患有II期（n = 2）、IIIA期（n = 6）、IIIC期（n = 18）和IV期（n = 1）疾病。85.2%的患者实现了最佳细胞减灭至无大体残留。96%的肿瘤表达雌激素受体，而只有32%表达孕激素受体。55.5%的病例术后使用来曲唑，37.1%的病例使用阿那曲唑，7.4%的病例使用他莫昔芬。在中位随访41个月后，只有6名患者（22.2%）出现肿瘤复发，2名患者死于疾病。中位PFS和OS尚未达到，但2年PFS和OS分别为82.8%和96.3%，3年PFS和OS分别为79.0%和92.6%。我们的系列报道描述了对II-IV期原发性卵巢LGSC患者进行细胞减灭术和激素单药治疗的初步经验。虽然手术仍然是治疗的主要手段，但接受辅助激素治疗的晚期疾病患者可能不需要化疗。一个合作小组，III期试验计划确定最佳的治疗方法，妇女与这种卵巢癌亚型。(C)2017爱思唯尔公司All rights reserved.
Objectives. Women with advanced-stage, low-grade serous ovarian carcinoma (LGSC) have low chemotherapy response rates and poor overall survival. Most LGSC tumors overexpress hormone receptors, which represent a potential treatment target. Our study objective was to determine the outcomes of patients with advanced-stage LGSC treated with primary cytoreductive surgery (CRS) and hormone therapy (HT).Methods. A retrospective study was performed at two academic cancer centers. Patients with Stage II-IV LGSC underwent either primary or interval CRS followed by adjuvant HT between 2004 and 2016. Gynecologic pathologists reviewed all cases. Two-year progression-free (PFS) and overall survival (OS) were calculated.Results. Twenty-seven patients were studied; primary CRS followed by HT were administered in 26, while 1 patient had neoadjuvant chemotherapy followed by CRS and HT. The median patient age was 47.5, and patients had Stage II (n = 2), Stage IIIA (n = 6), Stage IIIC (n = 18), and Stage IV (n = 1) disease. Optimal cytoreduction to no gross residual was achieved in 85.2%. Ninety six percent of tumors expressed estrogen receptors, while only 32% expressed progesterone receptors. Letrozole was administered post operatively in 55.5% cases, anastrozole in 37.1% and tamoxifen in 7.4%. After a median follow up of 41 months, only 6 patients (22.2%) have developed a tumor recurrence and two patients have died of disease. Median PFS and OS have not yet been reached, but 2-year PFS and OS were 82.8% and 96.3%, respectively, and 3-year PFS and OS were 79.0% and 92.6%, respectively.Conclusions. Our series describes the initial experience with cytoreductive surgery and hormonal monotherapy for women with Stage II-IV primary ovarian LGSC. While surgery remains the mainstay of treatment, chemotherapy may not be necessary in patients with advanced-stage disease who receive adjuvant hormonal therapy. A cooperative group, Phase III trial is planned to define the optimal therapy for women with this ovarian carcinoma subtype. (C) 2017 Elsevier Inc. All rights reserved.