Prognostic factors modifying the treatment-free interval in recurrent ovarian cancer.
Prognostic factors modifying the treatment-free interval in recurrent ovarian cancer.
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DOI：
10.1016/j.ygyno.2015.09.011
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发表时间：
2015-11
影响因子：
4.7
通讯作者：
Szender JB
中科院分区：
文献类型：
--
作者：
Eng KH;Hanlon BM;Bradley WH;Szender JB
虽然高级别浆液性卵巢癌的主要治疗往往是统一的-最大减积和铂/紫杉烷辅助化疗-除了彻底使用铂治疗外，复发性疾病的治疗几乎没有标准化。使用来自参与癌症基因组图谱研究（TCGA）的多个中心的次要数据，我们试图描述临床特征，时间和系列反应数据，为复发性疾病的治疗预期提供经验证据。我们对TCGA研究的主要和次要患者化疗方案进行了回顾性生存分析，描述了包括461例高级别浆液性卵巢癌患者治疗在内的1119种治疗方案的动力学特征。本研究纳入了TCGA数据库中具有术后药物治疗信息的所有患者。对辅助治疗的完全反应导致更长的总生存期，但不影响疾病复发后的无治疗间期（TFI）。下一个治疗方案的TFI的强预测因子是具有衰减效应的先前TFI。既往治疗次数、铂类药物治疗次数和手术后时间长度均对TFI呈指数下降影响。再次治疗时间似乎集中在术后可预测的时间。虽然患者的TFI随着再治疗的增加而持续降低，但初始辅助治疗间隔与后续间隔时间无关。铂类药物再治疗仍然是通常认为铂类药物耐药的患者的有效选择，监测访视的时间可能会影响总体再治疗模式。
While primary treatment for high-grade serous ovarian cancer tends to be uniform – maximal debulking and platinum/taxane adjuvant chemotherapy – there is little standardization of treatment in the recurrent setting beyond the exhaustive use of platinum therapies. Using secondary data from multiple centers participating in the Cancer Genome Atlas study (TCGA), we seek to characterize clinical features, timing and serial response data to provide empirical evidence for treatment expectations in the recurrent setting. We conducted a retrospective survival analysis of TCGA study primary and secondary patient chemotherapy regimens by characterizing the dynamics of 1119 lines of therapy comprising the treatment of 461 high-grade serous ovarian cancer patients. All patients with post-surgical drug therapy information from the TCGA database were included in this study. A complete response to adjuvant therapy led to longer overall survival, but did not affect treatment free intervals (TFI) after relapse of disease. A strong predictor of the TFI on the next treatment regimen was the previous TFI with a decaying effect. The number of previous treatments, of platinum treatments, and the length of time from surgery all have an exponentially decreasing effect on TFI. Re-treatment times appear to cluster at predictable times following surgery. While patients experience a consistent reduction in TFI with increasing re-treatment, the initial adjuvant interval is unrelated to later interval lengths. Platinum re-treatment remained an effective option in patients typically thought to be platinum resistant and the timing of monitoring visits may drive overall re-treatment patterns.