Eisenkop S M, Spirtos N M, Montag T W, Nalick R H, Wang H J
Center for Gynecologic Oncology, Encino, California 91436.
Gynecol Oncol. 1992 Nov;47(2):203-9. doi: 10.1016/0090-8258(92)90107-t.
A retrospective study was conducted to determine the influence of subspecialty training in gynecologic oncology as well as several other covariates on the feasibility, operative mortality, and survival benefits of cytoreductive surgery for 263 patients with stages IIIC and IVA epithelial ovarian cancer. Covariates most predictive of an optimal (< or = 1 cm) cytoreductive outcome were the diameter of the largest metastases before cytoreduction (< or = 10 cm vs > 10 cm, P < 0.001) and the specialty training of the physicians present at surgery (gynecologic oncologists vs other, P < 0.001). Age influenced operative mortality most (< 60 vs > or = 60, P < 0.001). Covariates found to most significantly influence survival time include the specialty training of the physicians present at surgery (gynecologic oncologists vs other, P < 0.0001), cytoreductive outcome (complete vs optimal, P = 0.001, optimal vs suboptimal, P < 0.0001), grade of tumor (grade 1 vs grades 2 and 3, P = 0.01), and pelvic disease status (frozen pelvis vs mobile primary tumor, P = 0.03). We conclude that patients with advanced epithelial ovarian cancer should undergo aggressive cytoreductive surgery by gynecologic oncologists, with the objective to remove all macroscopic disease. Subsequent treatment with platinum-based chemotherapy offers the best chance for long-term survival or cure.
开展了一项回顾性研究，以确定妇科肿瘤亚专业培训以及其他几个协变量对263例IIIC期和IVA期上皮性卵巢癌患者进行肿瘤细胞减灭术的可行性、手术死亡率和生存获益的影响。最能预测最佳（≤1 cm）肿瘤细胞减灭结果的协变量是细胞减灭术前最大转移灶的直径（≤10 cm与>10 cm，P<0.001）以及手术时在场医生的专业培训（妇科肿瘤学家与其他医生，P<0.001）。年龄对手术死亡率影响最大（<60岁与≥60岁，P<0.001）。发现对生存时间影响最显著的协变量包括手术时在场医生的专业培训（妇科肿瘤学家与其他医生，P<0.0001）、肿瘤细胞减灭结果（完全切除与最佳切除，P=0.001，最佳切除与次优切除，P<0.0001）、肿瘤分级（1级与2级和3级，P=0.01）以及盆腔疾病状态（冰冻盆腔与可活动的原发肿瘤，P=0.03）。我们得出结论，晚期上皮性卵巢癌患者应由妇科肿瘤学家进行积极的肿瘤细胞减灭术，目标是切除所有肉眼可见的病灶。随后进行铂类化疗为长期生存或治愈提供了最佳机会。
