Eisenkop S M, Spirtos N M
Women's Cancer Center, Encino-Tarzana, 5525 Etiwanda Avenue, Suite 311, Tarzana, California 91356, USA.
Gynecol Oncol. 2001 Sep;82(3):435-41. doi: 10.1006/gyno.2001.6313.
The aim of this study was to determine if the necessity of using specific procedures to attain complete cytoreduction in ovarian cancer correlates with innate biologic aggressiveness and independently influences survival.
Between 1990 and 2000, 213 patients with Stage IIIC epithelial ovarian cancer underwent complete cytoreduction before initiation of systemic platinum-based combination chemotherapy. Survival was stratified and analyzed (log rank and Cox regression) on the basis of whether extrapelvic bowel resection, diaphragm stripping, full-thickness diaphragm resection, modified posterior pelvic exenteration, peritoneal implant ablation and/or aspiration, and excision of grossly involved retroperitoneal lymph nodes were necessary to attain a visibly disease-free cytoreductive outcome.
The median and estimated 5-year survival for the cohort were 75.8 months and 54%, respectively. Survival was influenced (log rank) by the requirement of diaphragm stripping (required, median 42 months vs not required, median 79 months; P = 0.03) and the extent of mesenteric and serosal implants that required removal (none, median not reached, vs 1-50 implants, median not reached, vs >50 implants, median 40 months; P = 0.002). Survival was independently influenced (Cox regression) only by the extent of peritoneal metastatic implants that required removal (P = 0.01). The other investigated procedures and type of chemotherapy used did not influence survival.
The need to remove a large number of peritoneal implants correlates with biological aggressiveness and diminished survival, but not significantly enough to preclude long-term survival or justify abbreviation of the operative effort. The need to use the other investigated procedures had minimal or no observed influence on survival.
本研究旨在确定在卵巢癌中采用特定手术步骤以实现完全细胞减灭的必要性是否与内在生物学侵袭性相关，并独立影响生存率。
1990年至2000年间，213例IIIC期上皮性卵巢癌患者在开始基于铂类的全身联合化疗前接受了完全细胞减灭术。根据实现肉眼无病的细胞减灭结果是否需要盆腔外肠切除术、膈肌剥脱术、全层膈肌切除术、改良后盆腔脏器清除术、腹膜种植灶消融和/或抽吸以及切除明显受累的腹膜后淋巴结，对生存率进行分层和分析（对数秩检验和Cox回归）。
该队列的中位生存期和估计5年生存率分别为75.8个月和54%。生存率受膈肌剥脱术需求的影响（对数秩检验）（需要，中位生存期42个月 vs 不需要，中位生存期79个月；P = 0.03）以及需要切除的肠系膜和浆膜种植灶范围的影响（无，中位生存期未达到，vs 1 - 50个种植灶，中位生存期未达到，vs >50个种植灶，中位生存期40个月；P = 0.002）。生存率仅受需要切除的腹膜转移种植灶范围的独立影响（Cox回归）（P = 0.01）。其他研究的手术步骤和所用化疗类型不影响生存率。
需要切除大量腹膜种植灶与生物学侵袭性和生存率降低相关，但程度不足以排除长期生存或证明缩短手术努力的合理性。使用其他研究的手术步骤对生存率的影响极小或未观察到有影响。
