Bristow Robert E, Tomacruz Rafael S, Armstrong Deborah K, Trimble Edward L, Montz F J
Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medical Institutions, Baltimore, MD 21287-1248, USA.
J Clin Oncol. 2002 Mar 1;20(5):1248-59. doi: 10.1200/JCO.2002.20.5.1248.
To evaluate the relative effect of percent maximal cytoreductive surgery and other prognostic variables on survival among cohorts of patients with advanced-stage ovarian carcinoma treated with platinum-based chemotherapy.
Eighty-one cohorts of patients with stage III or IV ovarian carcinoma (6,885 patients) were identified from articles in MEDLINE (1989 through 1998). Linear regression models, with weighted correlation calculations, were used to assess the effects on log median survival time of the proportion of each cohort undergoing maximal cytoreduction, dose-intensity of the platinum compound administered, proportion of patients with stage IV disease, median age, and year of publication.
There was a statistically significant positive correlation between percent maximal cytoreduction and log median survival time, and this correlation remained significant after controlling for all other variables (P <.001). Each 10% increase in maximal cytoreduction was associated with a 5.5% increase in median survival time. When actuarial survival was estimated, cohorts with < or = 25% maximal cytoreduction had a mean weighted median survival time of 22.7 months, whereas cohorts with more than 75% maximal cytoreduction had a mean weighted median survival time of 33.9 months--an increase of 50%. The relationship between platinum dose-intensity and log median survival time was not statistically significant.
During the platinum era, maximal cytoreduction was one of the most powerful determinants of cohort survival among patients with stage III or IV ovarian carcinoma. Consistent referral of patients with apparent advanced ovarian cancer to expert centers for primary surgery may be the best means currently available for improving overall survival.
评估最大程度细胞减灭术的百分比及其他预后变量对接受铂类化疗的晚期卵巢癌患者队列生存的相对影响。
从MEDLINE（1989年至1998年）收录的文章中识别出81个III期或IV期卵巢癌患者队列（6885例患者）。采用线性回归模型及加权相关计算，评估每个队列接受最大程度细胞减灭术的比例、所给予铂类化合物的剂量强度、IV期疾病患者的比例、中位年龄及发表年份对对数中位生存时间的影响。
最大程度细胞减灭术的百分比与对数中位生存时间之间存在统计学显著正相关，在控制所有其他变量后，这种相关性仍然显著（P<.001）。最大程度细胞减灭术每增加10%，中位生存时间增加5.5%。当估计精算生存率时，最大程度细胞减灭术≤25%的队列平均加权中位生存时间为22.7个月，而最大程度细胞减灭术超过75%的队列平均加权中位生存时间为33.9个月，增加了50%。铂剂量强度与对数中位生存时间之间的关系无统计学显著意义。
在铂类治疗时代，最大程度细胞减灭术是III期或IV期卵巢癌患者队列生存的最有力决定因素之一。将明显晚期卵巢癌患者持续转诊至专家中心进行初次手术可能是目前提高总体生存率的最佳方法。
