Eisenkop Scott M, Spirtos Nick M, Lin Wei-Chien Michael
Women's Cancer Center, Southern California, 4835 Van Nuys Blvd., Suite 109, Sherman Oaks, CA 91403, USA.
Gynecol Oncol. 2006 Oct;103(1):329-35. doi: 10.1016/j.ygyno.2006.07.004. Epub 2006 Jul 31.
To derive the most appropriate threshold to classify primary cytoreductive operations as "optimal" and address the clinical significance of this issue.
Criteria used to classify primary cytoreductive outcomes are reviewed. Survival outcomes are analyzed to address relative influences of the completeness of cytoreduction and "biological aggressiveness", as manifested by the extent of intra-abdominal metastases.
Most cohorts analyzing relative influences of metastatic tumor burden and the dimension of residual disease on survival report completeness of cytoreduction to influence the prognosis more significantly than tumor burden, with necessity to perform various procedures having minimal or no influence. Equivalent survival is reported for completely cytoreduced patients with stage III disease whether substages IIIa/b (smaller tumor burden) are excluded or included. However, some stage IIIc series report more favorable median and 5-year survivals for small fractions of completely cytoreduced patients than series with a large visibly disease-free fraction. Increasing fractions of complete cytoreduction are reported in recent cohorts, without increase in morbidity.
Complete primary cytoreduction improves the prognosis for survival significantly more than a small dimension of residual disease. Although prospective randomized trials addressing surgical issues have not been undertaken and numerous variables may reflect "biological aggressiveness" by influencing the prognosis, available data justify elimination of macroscopic disease to be the most appropriate objective of primary cytoreductive surgery. Stratification of survival by dimensions of residual disease in an investigational setting should include a visibly disease-free subgroup and if used, the term "optimal" should be applied to patients undergoing complete cytoreduction.
确定将原发性细胞减灭术分类为“最佳”的最合适阈值，并探讨该问题的临床意义。
回顾用于分类原发性细胞减灭术结果的标准。分析生存结果，以探讨细胞减灭的完整性和“生物学侵袭性”（以腹腔内转移程度表现）的相对影响。
大多数分析转移性肿瘤负荷和残留病灶大小对生存的相对影响的队列研究报告称，细胞减灭的完整性比肿瘤负荷对预后的影响更显著，进行各种手术的必要性影响最小或无影响。对于III期疾病完全细胞减灭的患者，无论是否排除IIIa/b亚期（肿瘤负荷较小），报告的生存率相当。然而，一些IIIc期系列研究报告称，一小部分完全细胞减灭的患者的中位生存期和5年生存率比无可见疾病的比例大的系列更有利。最近的队列研究报告称，完全细胞减灭的比例增加，而发病率没有增加。
完全原发性细胞减灭比小尺寸的残留病灶更能显著改善生存预后。尽管尚未进行针对手术问题的前瞻性随机试验，且许多变量可能通过影响预后反映“生物学侵袭性”，但现有数据证明消除肉眼可见的疾病是原发性细胞减灭手术最合适的目标。在研究环境中按残留病灶大小对生存进行分层应包括一个无可见疾病的亚组，如果使用该术语，“最佳”应适用于接受完全细胞减灭的患者。
