术前肿瘤体积和肿瘤细胞减灭术结果对晚期卵巢癌患者生存的相对影响：一项前瞻性研究。

Relative influences of tumor volume before surgery and the cytoreductive outcome on survival for patients with advanced ovarian cancer: a prospective study.

作者信息

Eisenkop Scott M, Spirtos Nick M, Friedman Richard L, Lin Wei-Chien Michael, Pisani Albert L, Perticucci Sergio

机构信息

Women's Cancer Center: Encino-Tarzana, 5525 Etiwanda Ave., Suite 311, Tarzana, CA 91356, USA.

出版信息

Gynecol Oncol. 2003 Aug;90(2):390-6. doi: 10.1016/s0090-8258(03)00278-6.

DOI:10.1016/s0090-8258(03)00278-6

PMID:12893206

Abstract

OBJECTIVE

The purpose of this study was to determine the relative influences of the extent of disease present before surgery and completeness of cytoreduction on survival for patients with advanced ovarian cancer.

METHODS

Patients (408) with stage IIIC epithelial ovarian cancer had cytoreductive surgery before systemic platinum-based combination chemotherapy. A ranking system (0-3) was devised to prospectively quantify the extent of disease involving: (1) right upper quadrant (diaphragm/hepatic, and adjacent peritoneal surfaces), (2) left upper quadrant (omentum/gastro-colic ligament, spleen, stomach, transverse colon, splenic flexure of colon), (3) pelvis (reproductive organs, recto-sigmoid, pelvic peritoneum), (4) retroperitoneum (pelvic/aortic nodes), and (5) central abdomen (small bowel, ascending/descending colon, mesentery, anterior abdominal wall, pericolic gutters). Survival was analyzed (log rank and Cox regression) on the basis of the rankings at these anatomic regions, the sum of intraabdominal rankings, and the cytoreductive outcome.

RESULTS

Overall median and estimated 5-year survivals were 58.2 months and 49%. On univariate analysis, the central abdominal (P = 0.008) and left upper quadrant (P = 0.03) rankings, the sum of rankings (P = 0.01), and the cytoreductive outcome (P </= 0.0001) influenced survival (log rank). Survival was independently (stepwise Cox model) influenced by the sum of rankings (0-5, RR 1.00; 6-10, RR 1.24; 11-15, RR 1.44; P = 0.05), and completeness of cytoreduction (visibly disease-free, RR 1.00; </=1 cm residual, RR 2.32; >1 cm residual, RR 2.98; P = 0.001).

CONCLUSIONS

Cytoreduction to a visibly disease-free outcome has a more significant influence on survival than the extent of metastatic disease present before surgery. Operative efforts should not be abbreviated on the hypothesis that extensive disease at specific anatomic regions precludes long-term survival.

摘要

目的

本研究旨在确定手术前疾病范围和肿瘤细胞减灭术的彻底性对晚期卵巢癌患者生存的相对影响。

方法

408例IIIC期上皮性卵巢癌患者在接受基于铂类的全身联合化疗前接受了肿瘤细胞减灭术。设计了一个分级系统（0 - 3级）来前瞻性地量化疾病累及范围：（1）右上腹（膈肌/肝脏及相邻腹膜表面），（2）左上腹（大网膜/胃结肠韧带、脾脏、胃、横结肠、结肠脾曲），（3）盆腔（生殖器官、直肠乙状结肠、盆腔腹膜），（4）腹膜后（盆腔/主动脉旁淋巴结），以及（5）中腹部（小肠、升/降结肠、肠系膜、前腹壁、结肠旁沟）。根据这些解剖区域的分级、腹腔内分级总和以及肿瘤细胞减灭术的结果分析生存率（对数秩检验和Cox回归）。

结果

总体中位生存期和估计5年生存率分别为58.2个月和49%。单因素分析显示，中腹部（P = 0.008）和左上腹（P = 0.03）分级、分级总和（P = 0.01）以及肿瘤细胞减灭术结果（P≤0.0001）影响生存率（对数秩检验）。生存率受到分级总和（0 - 5，RR 1.00；6 - 10，RR 1.24；11 - 15，RR 1.44；P = 0.05）和肿瘤细胞减灭术彻底性（肉眼无疾病残留，RR 1.00；残留≤1 cm，RR 2.32；残留>1 cm，RR 2.98；P = 0.001）的独立影响（逐步Cox模型）。