Zang Rong-Yu, Li Zi-Ting, Tang Jie, Cheng Xi, Cai Shu-Mo, Zhang Zhi-Yi, Teng Nelson N
Department of Gynecologic Oncology, Cancer Hospital of Fudan University (formerly Shanghai Medical University), Shanghai, China.
Cancer. 2004 Mar 15;100(6):1152-61. doi: 10.1002/cncr.20106.
This study was performed to address patient selection criteria and the role of secondary cytoreductive surgery (SCR) in patients with epithelial ovarian carcinoma (EOC) who had relapsed tumors after a progression-free interval > or = 3 months.
One hundred seventeen patients with relapsed EOC after a clinical complete remission duration > or = 3 months who underwent SCR were entered on this prospective trial. Survival curves were generated using the Kaplan-Meier method, and statistical comparisons were performed using log-rank tests, logistic stepwise regression analyses, and a Cox stepwise regression model.
The median patient age at the time of relapse was 53 years (range, 20-78 years). The median survival was 22 months and the estimated 5-year survival rate for the entire cohort was 17.2%. Tumor was confined to a solitary site in 33 patients and to > or = 2 sites in 84 patients. After they underwent SCR, 11 patients were rendered macroscopically disease free, 61 patients had residual disease that measured < or = 1 cm in greatest dimension, and 45 patients had bulky intraabdominal residual disease. Survival was influenced by the extent of relapse disease (solitary site vs. multiple sites; P < 0.0001), the size of residual disease after SCR (0 cm vs. < or = 1 cm [P = 0.1211], < or = 1 cm vs. > 1 cm [P = 0.0002], and 0 cm vs. > 1 cm [P = 0.0011]), Eastern Cooperative Oncology Group performance status (0 vs. 1 [P = 0.134], 1 vs. 2 [P = 0.007], and 0 vs. 2 [P = 0.0012]), and the number of cycles of salvage chemotherapy (1-2 cycles vs. 3-5 cycles [P = 0.0144]; 1-2 cycles vs. > or = 6 cycles [P < 0.0001]; and 3-5 cycles vs. > or = 6 cycles [P = 0.0009]). The outcome of SCR was influenced by the extent of relapse disease (multiple sites [51.2%] vs. solitary sites [87.9%]; relative risk [RR] = 9.1237; P = 0.0002) and by the use of bowel resection (yes [60.9%] vs. no [37.5%]; RR = 0.3828; P = 0.0106).
SCR was found to be safe for patients with relapsed EOC who achieved a clinical complete remission that lasted > or = 3 months, with resectability similar to that of primary debulking surgery. Optimal surgical outcomes were achieved easily in patients who apparently had solitary tumor sites, with bowel resection making it possible to remove bulky tumors that involved the intestine. A survival benefit was provided by optimal SCR, particularly when surgery was supported by multiple courses of salvage chemotherapy.
本研究旨在探讨上皮性卵巢癌（EOC）患者在无进展生存期≥3个月后复发肿瘤时的患者选择标准以及二次细胞减灭术（SCR）的作用。
117例临床完全缓解持续时间≥3个月后复发的EOC患者接受了SCR，并纳入了这项前瞻性试验。采用Kaplan-Meier法生成生存曲线，并使用对数秩检验、逻辑逐步回归分析和Cox逐步回归模型进行统计学比较。
复发时患者的中位年龄为53岁（范围20 - 78岁）。中位生存期为22个月，整个队列的估计5年生存率为17.2%。33例患者肿瘤局限于单个部位，84例患者肿瘤累及≥2个部位。接受SCR后，11例患者达到肉眼无疾病状态，61例患者残留病灶最大径≤1 cm，45例患者腹腔内残留病灶较大。生存受复发疾病范围（单个部位与多个部位；P < 0.0001）、SCR后残留病灶大小（0 cm与≤1 cm [P = 0.1211]，≤1 cm与> 1 cm [P = 0.0002]，以及0 cm与> 1 cm [P = 0.0011]）、东部肿瘤协作组体能状态（0与1 [P = 0.134]，1与2 [P = 0.007]，以及0与2 [P = 0.0012]）和挽救性化疗周期数（1 - 2个周期与3 - 5个周期[P = 0.0144]；1 - 2个周期与≥6个周期[P < 0.0001]；以及3 - 5个周期与≥6个周期[P = 0.0009]）的影响。SCR的结果受复发疾病范围（多个部位[51.2%]与单个部位[87.9%]；相对危险度[RR] = 9.1237；P = 0.0002）和肠切除术的使用情况（是[60.9%]与否[37.5%]；RR = 0.3828；P = 0.0106）的影响。
对于临床完全缓解持续时间≥3个月的复发EOC患者，发现SCR是安全的，其可切除性与初次肿瘤细胞减灭术相似。明显为单个肿瘤部位的患者很容易获得最佳手术效果，肠切除术使得切除累及肠道的较大肿瘤成为可能。最佳的SCR可带来生存获益，特别是在手术得到多疗程挽救性化疗支持时。
