Aletti Giovanni D, Dowdy Sean C, Podratz Karl C, Cliby William A
Department of Obstetrics and Gynecology, Mayo Clinic and Foundation, Rochester, MN 55905, USA.
Am J Obstet Gynecol. 2007 Dec;197(6):676.e1-7. doi: 10.1016/j.ajog.2007.10.495.
Advanced ovarian cancer (OC) is associated with impaired performance status and comorbidities for many patients. These factors have an impact on the decision to perform extended surgical cytoreduction. However, the trade-off between short-term morbidity and overall survival is complex, and few data are available analyzing the combined effects of these variables.
The purpose of the study was to evaluate the impact of patients' age and American Society of Anesthesiologists (ASA) and surgical complexity score (SCS) on short-term morbidity and overall survival.
Presurgical patient characteristics, surgical procedures performed, and outcomes were assessed in a cohort of consecutive primary OC patients. An SCS from 1 to 3 was developed to adjust for the extent of surgery (simple to complex, respectively). Primary outcomes were 30 day major morbidity (sepsis, thromboembolic, cardiac, or reoperation), 3 month mortality, and overall survival (OS).
Two hundred nineteen consecutive patients with stage IIIC-IV OC were included. We observed a correlation between ASA and both short-term morbidity (P = .006) and 3 month mortality (P = .006). Age was independently associated with both short-term morbidity (P = .010) and 3 month mortality (P = .005). SCS correlated directly with morbidity (P < .001) but was not correlated with mortality (P = .266). The independent predictors of morbidity (ASA, age, and SCS) were used to develop risk prediction categories: risk of expected complications ranged from 2.5% to 67.6%, depending on category. Despite the increased risk of complications, however, more complex surgery carried a survival benefit in all the risk groups, owing to the observation that residual disease (RD) and SCS held a prognostic significance independent of age and ASA (P < .001 and P = .001, respectively).
Because of the survival benefit from lower RD, a less aggressive surgical effort results in poorer OS. However, the risk of complications are substantial for complex surgeries in the highest-risk patients: risk stratification should be used to help plan perioperative care and consider optimal treatment planning.
对于许多晚期卵巢癌（OC）患者而言，其身体机能状态受损且伴有多种合并症。这些因素会影响是否进行扩大手术细胞减灭术的决策。然而，短期发病率与总生存期之间的权衡较为复杂，且几乎没有数据可用于分析这些变量的综合影响。
本研究旨在评估患者年龄、美国麻醉医师协会（ASA）分级以及手术复杂程度评分（SCS）对短期发病率和总生存期的影响。
对一组连续性原发性OC患者的术前患者特征、所实施的手术操作及结果进行评估。制定了1至3级的SCS以调整手术范围（分别为简单至复杂）。主要结局指标为30天严重发病率（脓毒症、血栓栓塞、心脏相关或再次手术）、3个月死亡率以及总生存期（OS）。
纳入了219例连续性IIIC-IV期OC患者。我们观察到ASA与短期发病率（P = 0.006）和3个月死亡率（P = 0.006）均存在相关性。年龄与短期发病率（P = 0.010）和3个月死亡率（P = 0.005）均独立相关。SCS与发病率直接相关（P < 0.001），但与死亡率无关（P = 0.266）。利用发病率的独立预测因素（ASA、年龄和SCS）来划分风险预测类别：预期并发症风险根据类别不同在2.5%至67.6%之间。然而，尽管并发症风险增加，但由于观察到残留病灶（RD）和SCS具有独立于年龄和ASA的预后意义（分别为P < 0.001和P = 0.001），在所有风险组中，更复杂的手术都具有生存获益。
由于较低的RD具有生存获益，手术力度较小会导致较差的OS。然而，对于最高风险患者进行复杂手术时并发症风险很大：应使用风险分层来帮助规划围手术期护理并考虑最佳治疗方案。
