Secondary Surgery Versus Chemotherapy for Recurrent Ovarian Cancer.
Secondary Surgery Versus Chemotherapy for Recurrent Ovarian Cancer.
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DOI：
10.1097/coc.0000000000000310
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发表时间：
2018-05
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影响因子：
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通讯作者：
Deb P
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文献类型：
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作者：
Bickell NA;Egorova N;Prasad-Hayes M;Franco R;Howell EA;Wisnivesky J;Deb P
复发性卵巢癌的最佳治疗方案尚不确定。我们试图确定与其他治疗方法相比，卵巢癌首次复发的二次细胞减灭术是否能提高总生存率。我们使用1997年1月1日至2007年12月31日诊断的晚期卵巢癌病例的监测、流行病学和最终结果-医疗保险数据评估了生存率，使用多项倾向加权有限混合生存回归模型分析了2010年的生存数据，以区分真正的复发和错误分类的复发。在35，995名年龄在66岁及以上的卵巢癌女性中，3439名接受了6个周期化疗的最佳原发性减瘤手术; 2038名患者病情缓解。2038名妇女中有1635名（80%）接受了复发治疗，其中72%仅接受化疗，16%接受了手术和化疗，12%接受了临终关怀。接受单纯化疗、手术加化疗或临终关怀治疗的妇女的中位生存期分别为4.1年、5.4年和2.2年（p<0.001）。在未接受二次治疗的患者中，75%可能是真正的非复发性，中位生存期为15.9年，25%被错误分类，生存期为2.4年。与单纯化疗相比，接受手术和化疗的复发妇女的生存率更高（HR=1.67; 95%置信区间：1.13-2.47）。年龄越大、合并症越多、癌症级别越高的女性生存率越低。与单纯化疗相比，二次手术联合化疗治疗复发性卵巢癌可使生存期延长1.3年，并且正在进行的随机试验结果可能被视为标准治疗。
The best course of treatment for recurrent ovarian cancer is uncertain. We sought to determine whether secondary cytoreductive surgery for first recurrence of ovarian cancer improves overall survival compared to other treatments. We assessed survival using Surveillance, Epidemiology and End Results-Medicare data for advanced stage ovarian cancer cases diagnosed from January 1, 1997- December 31, 2007 with survival data through 2010 using multinomial propensity weighted finite mixture survival regression models to distinguish true from misclassified recurrences. Of 35,995 women ages 66 years and older with ovarian cancer, 3439 underwent optimal primary debulking surgery with 6 cycles of chemotherapy; 2038 experienced a remission. 1635 out of 2038 (80%) women received treatment for recurrence of whom 72% were treated with chemotherapy only, 16% with surgery and chemotherapy and 12% received hospice care. Median survival of women treated with chemotherapy alone, surgery and chemotherapy, or hospice care was 4.1 years, 5.4 years, and 2.2 years, respectively (p<0.001). Of those receiving no secondary treatments, 75% were likely true nonrecurrences with median survival of 15.9 years and 25% misclassified with 2.4 years survival. Survival among women with recurrence was greater for those treated with surgery and chemotherapy compared to chemotherapy alone (HR=1.67; 95% confidence interval: 1.13–2.47). Women who were older with more comorbidities and high grade cancer had worse survival. Secondary surgery with chemotherapy to treat recurrent ovarian cancer increases survival by 1.3 years compared to chemotherapy alone and pending ongoing randomized trial results, may be considered a standard of care.