Are There Survival Differences Between Women with Equivalent Residual Disease After Interval Cytoreductive Surgery Compared with Primary Cytoreductive Surgery for Advanced Ovarian and Peritoneal Cancer?
Are There Survival Differences Between Women with Equivalent Residual Disease After Interval Cytoreductive Surgery Compared with Primary Cytoreductive Surgery for Advanced Ovarian and Peritoneal Cancer?
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DOI：
10.1245/s10434-020-09304-w
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发表时间：
2020-11-05
影响因子：
3.7
通讯作者：
Gehrig, Paola A.
中科院分区：
文献类型：
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作者：
Mysona, David Pierce;Ghamande, Sharad;Gehrig, Paola A.
目的探讨原发性肿瘤减积手术（PDS）和间歇性肿瘤减积手术（IDS）时的等效残留病变（完全大体切除（CGR）、微小残留病变（MRD）、次优）患者的生存差异。方法使用美国国家癌症数据库，识别2010年至2015年记录有残留病变的IIIC/IV期原发性腹膜癌或卵巢癌患者。倾向评分匹配（PSM）用于校正PDS和IDS组之间的特征差异。结果在8683例晚期卵巢癌患者中，分别有4493例（52%）、2546例（29%）和1644例（19%）进行了CGR、MRD或次优切除。从2010年到2015年，接受IDS的患者数量增加了27%（p（趋势）< 0.001），CGR增加了18%（p（趋势）= 0.005）。2010年至2015年IDS使用的增加与CGR增加（p（趋势）= 0.02）和MRD减少（p（趋势）= 0.001）相关，但与次优切除减少无关（p（趋势）= 0.18）。即使在PSM后，IDS也与较差的总生存期相关[OS;风险比（HR）1.12，95%置信区间（CI）1.03-1.22，p = 0.008]。PDS时的CGR与IDS时的CGR相比，中位OS延长（51个月vs. 44个月，p < 0.001）。此外，与IDS的CGR相比，PDS的MRD的中位OS更差（41 vs. 44个月，p = 0. 03），但与IDS的MRD相比，中位OS有所改善（中位OS 35个月，p = 0. 05）。结论：IDS的使用在美国持续上升，与手术结局的改善相关，但不一定与肿瘤结局相似。应该继续努力改善晚期卵巢和腹膜恶性肿瘤患者的细胞减灭术结局。
Objective The aim of this study was to investigate survival differences between equivalent residual disease [complete gross resection (CGR), minimal residual disease (MRD), suboptimal] at the time of primary debulking surgery (PDS) and interval debulking surgery (IDS). Methods The National Cancer Database was used to identify patients from 2010 to 2015 with stage IIIC/IV primary peritoneal or ovarian cancer who had residual disease recorded. Propensity score matching (PSM) was used to correct for differences in characteristics between the PDS and IDS groups. Results Of 8683 patients with advanced ovarian cancer, 4493 (52%), 2546 (29%), and 1644 (19%) had CGR, MRD, or suboptimal resection, respectively. From 2010 to 2015, the number of patients undergoing IDS increased 27% (p(trend) < 0.001), and there was an 18% increase in CGRs (p(trend) = 0.005). The increased use of IDS from 2010 to 2015 was associated with increased CGRs (p(trend) = 0.02) and decreased MRD (p(trend) = 0.001), but not with decreased suboptimal resections (p(trend) = 0.18). IDS, even after PSM, was associated with inferior overall survival [OS; hazard ratio (HR) 1.12, 95% confidence interval (CI) 1.03-1.22, p = 0.008]. A CGR at PDS had prolonged median OS compared with a CGR at IDS (51 vs. 44 months, p < 0.001). Additionally, MRD at PDS had worse median OS compared with a CGR at IDS (41 vs. 44 months, p = 0.03), but improved median OS compared with MRD at IDS (median OS 35 months, p = 0.05). Conclusion The use of IDS continues to rise in the US, and is associated with improved surgical outcomes but not necessarily similar oncologic outcomes. There should be continued efforts to improve cytoreductive outcomes in women with advanced ovarian and peritoneal malignancies.