Is it justified to classify patients to Stage IIIC epithelial ovarian cancer based on nodal involvement only?
Is it justified to classify patients to Stage IIIC epithelial ovarian cancer based on nodal involvement only?
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DOI：
10.1016/j.ygyno.2006.08.047
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发表时间：
2006-12-01
影响因子：
4.7
通讯作者：
Podratz, Karl C.
中科院分区：
文献类型：
--
作者：
Cliby, William A.;Aletti, Giovanni D.;Podratz, Karl C.
背景IIIC期上皮性卵巢癌通常与大于2cm的上腹部肿瘤植入物相关，预后严重。一部分患者由于淋巴结转移而升级至IIIC期，其中预后不明确。我们进行了这项研究，以描述隐匿性III期的临床行为。分析9年期间（1994-2002）发现的所有连续IIIC期卵巢上皮癌患者的手术操作、病理、无病生存率（DFS）和总生存率（OS）。36例患者因阳性淋巴结而升级至IIIC期。9例患者有小体积上腹部疾病（在升级前为IIIA/B），15例疾病局限于骨盆，12例疾病局限于卵巢。32/36例患者在手术结束时无大体残留病变。所有患者的5年DFS和OS生存率分别为52%和76%。我们观察到IIIA/B期和I-II期疾病患者的预后无显著差异。结果上级，手术开始时肿瘤细胞减少至无大体RD或RD <1cm的上腹部大体积病变患者的疗效优于对照组（P < 0.001）。相对于所有IIIC期疾病患者，因淋巴结受累而升期至IIIC期上皮性卵巢癌的患者具有极佳的5年OS。这些数据表明，在比较结局时，有必要仅根据淋巴结疾病对IIIC期疾病患者进行分层。这些信息在为患者提供预后咨询时特别有价值。(c)2006年爱思唯尔公司All rights reserved.
Background. Stage IIIC epithelial ovarian cancer is generally associated with upper abdominal tumor implants of greater than 2 cm and carries a grave prognosis. A subset of patients is upstaged to Stage IIIC because of lymph node metastases, in which prognosis is not well defined. We undertook this study to describe the clinical behavior of occult Stage IIIC.Methods. All consecutive patients found to have Stage IIIC epithelial ovarian cancer during a 9-year period (1994-2002) were analyzed for surgical procedures, pathology, and disease-free (DFS) and overall survival (OS).Results. Thirty-six patients were upstaged to Stage IIIC by virtue of positive nodes. Nine had small volume upper abdominal disease (IIIA/B before upstaging), 15 had disease limited to the pelvis and 12 had disease confined to the ovaries. 32/36 patients had no gross residual disease at the conclusion of surgery. The 5-year DFS and OS survivals were 52% and 76% respectively, for all patients. We observed no significant difference in outcomes between patients upstaged from IIIA/B versus I-II stage disease. The outcomes were superior to a control group of patients cytoreduced to either no gross RD or RD < I cm, who had large volume upper abdominal disease at beginning of surgery (P < 0.001).Conclusions. Patients upstaged to Stage IIIC epithelial ovarian cancer for node involvement have an excellent 5-year OS relative to all patients with Stage IIIC disease. These data demonstrate the necessity for stratifying patients classified as having Stage IIIC disease based solely on nodal disease when comparing outcomes. This information is particularly valuable when counseling patients regarding prognosis. (c) 2006 Elsevier Inc. All rights reserved.