Potential Role of Lymphadenectomy in Advanced Ovarian Cancer: A Combined Exploratory Analysis of Three Prospectively Randomized Phase III Multicenter Trials
Potential Role of Lymphadenectomy in Advanced Ovarian Cancer: A Combined Exploratory Analysis of Three Prospectively Randomized Phase III Multicenter Trials
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DOI：
10.1200/jco.2009.25.3617
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发表时间：
2010-04-01
影响因子：
45.3
通讯作者：
Pfisterer, Jacobus
中科院分区：
文献类型：
--
作者：
du Bois, Andreas;Reuss, Alexander;Pfisterer, Jacobus
目的原发性手术后铂/紫杉烷化疗是晚期卵巢癌的标准治疗方法。完全减胀的预后作用已被很好地描述；然而，系统盆腔和主动脉旁淋巴结切除术的影响及其与生物因素的相互作用仍未完全确定。方法：本研究对1995年至2002年间进行的3项前瞻性随机试验（Arbeitsgemeinschaft gynecologische Onkologie Studiengruppe Ovarialkarzinom试验3、5和7）进行了探索性分析，研究了铂/紫杉烷为基础的晚期卵巢癌化疗方案。结果共分析了1224例患者。淋巴结切除术与无大体残留疾病患者的高生存率相关。行和未行淋巴结切除术的患者中位生存时间分别为103个月和84个月，5年生存率分别为67.4%和59.2% (P = 0.0166)；多因素分析证实淋巴结切除术对总生存率有显著影响（OS；风险比[HR] = 0.74; 95% CI, 0.59 ~ 0.94; P = 0.0123）。对于残留肿瘤小至1 cm的患者，淋巴结切除术对OS的影响几乎没有达到显著性（HR = 0.85; 95% CI, 0.72 ~ 1.00; P = 0.0497）。对于小残留肿瘤和临床可疑淋巴结的患者，淋巴结切除术导致5年OS增加16% （log-rank检验，P = 0.0038）。结论晚期卵巢癌淋巴结切除术主要受益于腹腔内完全消肿的患者。然而，这一假设应该在前瞻性随机试验的背景下得到证实。中华临床杂志，28(2):1733-1739。(C) 2010年由美国临床肿瘤学会出版
PurposePrimary surgery followed by platinum/taxane-based chemotherapy is the standard therapy in advanced ovarian cancer. The prognostic role of complete debulking has been well described; however, the impact of systematic pelvic and para-aortic lymphadenectomy and its interaction with biologic factors are still not fully defined.MethodsThis was an exploratory analysis of three prospective randomized trials (Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom trials 3, 5, and 7) investigating platinum/taxane-based chemotherapy regimens in advanced ovarian cancer conducted between 1995 and 2002.ResultsOne thousand nine hundred twenty-four patients were analyzed. Lymphadenectomy was associated with superior survival in patients without gross residual disease. In patients with and without lymphadenectomy, the median survival time was 103 and 84 months, respectively, and 5-year survival rates were 67.4% and 59.2%, respectively (P = .0166); multivariate analysis confirmed a significant impact of lymphadenectomy on overall survival (OS; hazard ratio [HR] = 0.74; 95% CI, 0.59 to 0.94; P = .0123). In patients with small residual tumors up to 1 cm, the effect of lymphadenectomy on OS barely reached significance (HR = 0.85; 95% CI, 0.72 to 1.00; P = .0497). For patients with small residual tumors and clinically suspect nodes, lymphadenectomy resulted in a 16% gain in 5-year OS (log-rank test, P = .0038).ConclusionLymphadenectomy in advanced ovarian cancer might offer benefit mainly to patients with complete intraperitoneal debulking. However, this hypothesis should be confirmed in the context of a prospectively randomized trial. J Clin Oncol 28: 1733-1739. (C) 2010 by American Society of Clinical Oncology