Wimberger Pauline, Lehmann Nils, Kimmig Rainer, Burges Alexander, Meier Werner, Du Bois Andreas
Department of Gynecology and Obstetrics, University of Essen, Hufelandstr. 55, D-45122 Essen, Germany.
Gynecol Oncol. 2007 Jul;106(1):69-74. doi: 10.1016/j.ygyno.2007.02.026. Epub 2007 Mar 29.
No residual tumor as result of primary surgery in advanced ovarian cancer is known as one of the most important prognostic factors.
To evaluate the impact of different prognostic factors for surgical outcome and to evaluate the impact of surgical outcome on survival.
Surgical data as well as survival data were documented throughout the multi-center prospective randomized phase III trial (OVAR-3) of the AGO-OVAR and were used for this exploratory analysis. In this study 798 patients with FIGO IIB-IV were first operated then randomized and homogenously treated with cisplatin/paclitaxel or carboplatin/paclitaxel. Only patients with complete surgical data (n=761) entered this analysis.
Multivariable logistic regression analysis showed a significant decrease of probability for complete debulking without any macroscopic residual tumor for higher pre-operative tumor load (OR 0.32; 95% CI 0.17-0.61), higher FIGO stage (OR 0.22; 95% CI 0.13-0.39), worse performance status (OR 0.57; 95% CI 0.38-0.86), advanced age (OR 0.78; 95% CI 0.65-0.94) and presence of peritoneal carcinomatosis (OR 0.17; 95% CI 0.10-0.28). Surgery in centers with surgeons who performed comprehensive surgical debulking including retroperitoneal lymphadenectomy and peritoneal stripping was associated with higher rates of complete debulking compared to surgery in other centers (32.8% vs. 22.9%, p=0.007). This resulted in a markedly improved overall survival (p=0.045). This effect was held true after adjustment for prognostic factors (HR 0.77, 95% CI 0.63-0.94, p=0.012).
Post-operative residual tumor is one of the most important independent prognostic factor for survival. Our results suggest an advantage for aggressive primary surgery and complete debulking. This surgical goal was achieved more often in experienced centers.
晚期卵巢癌初次手术无残留肿瘤是最重要的预后因素之一。
评估不同预后因素对手术结果的影响，并评估手术结果对生存的影响。
在AGO-OVAR的多中心前瞻性随机III期试验（OVAR-3）中记录手术数据和生存数据，并用于此项探索性分析。本研究中，798例国际妇产科联盟（FIGO）IIB-IV期患者先接受手术，然后随机分组，并用顺铂/紫杉醇或卡铂/紫杉醇进行同质治疗。仅具有完整手术数据的患者（n = 761）进入本分析。
多变量逻辑回归分析显示，术前肿瘤负荷较高（比值比[OR] 0.32；95%置信区间[CI] 0.17 - 0.61）、FIGO分期较高（OR 0.22；95% CI 0.13 - 0.39）、体能状态较差（OR 0.57；95% CI 0.38 - 0.86）、高龄（OR 0.78；95% CI 0.65 - 0.94）以及存在腹膜癌转移（OR 0.17；95% CI 0.10 - 0.28）时，实现完全减瘤且无任何肉眼可见残留肿瘤的概率显著降低。与其他中心的手术相比，在有外科医生进行包括腹膜后淋巴结清扫和腹膜剥除在内的全面手术减瘤的中心进行手术，完全减瘤率更高（32.8%对22.9%，p = 0.007）。这导致总生存期显著改善（p = 0.045）。在对预后因素进行调整后，这一效果依然成立（风险比[HR] 0.77，95% CI 0.63 - 0.94，p = 0.012）。
术后残留肿瘤是生存最重要的独立预后因素之一。我们的结果表明积极的初次手术和完全减瘤具有优势。在经验丰富的中心更常实现这一手术目标。
