Chéreau E, Ballester M, Rouzier R, Coutant C, Daraï E
Hôpital Tenon, Service de Gynécologie-Obstétrique, AP-HP, Cancer Est, Université Pierre-et-Marie-Curie-Paris-VI, 4 Place Jussieu, 75005 Paris, France.
Bull Cancer. 2009 Dec;96(12):1189-97. doi: 10.1684/bdc.2009.0985.
Residual disease is the first predictive factor for survival in women with ovarian cancer. Neoadjuvant chemotherapy still has not proved superiority in terms of overall survival compared with complete initial resection. Hence, initial surgery remains the cornerstone of management for patients with advanced ovarian cancer. Various parameters have been proposed to evaluate the ability of complete resection. Clinical evaluation of peritoneal carcinomatosis and ascite is not relevant enough while general status (ASA score) is correlated with the risk of postoperative complications. Preoperative dosage of CA-125 higher than 500 UI/L seems to be related with an increase risk of sub-optimal surgery. Recently, some authors challenged its prognostic value. For a CA-125 threshold at 500 UI/L, sensitivity, specificity, positive and negative predictive values range from 58 to 78%, 64 to 89%, 64 to 84% and 35.7 to 85.4%, respectively. Imaging criteria failed to report concordant results. Indeed, sensitivity, specificity, positive and negative predictive values vary from 52 to 100%, 75 to 100%, 49% to 100% and 50 to 100%, respectively. High-correlation has been demonstrated for carcinomatosis scores evaluating the dissemination of the disease (AUCs of ROCs curves higher than 0.6). At laparotomy, for an Eisenkop score under 6, 99% of patients could benefit of complete resection. At laparoscopy, for a Fagotti score under 4, a complete cytoreduction could be obtained in 78% of patients. This score had the best AUC (0.76). Various scoring systems are available for surgeons to evaluate the resecability of advanced ovarian cancer. Among them, peroperative scoring systems appear the best tool and should be recommended in routine especially at first laparoscopy. Finally, due to the impact on survival of complete initial resection, women with advanced ovarian cancer should be referred to specialized centres.
残留病灶是卵巢癌女性患者生存的首要预测因素。与初次完全切除相比，新辅助化疗在总生存方面尚未证明具有优越性。因此，初始手术仍然是晚期卵巢癌患者治疗的基石。已提出各种参数来评估完全切除的能力。腹膜癌病和腹水的临床评估相关性不足，而一般状况（ASA评分）与术后并发症风险相关。术前CA-125剂量高于500 UI/L似乎与手术未达最佳效果的风险增加有关。最近，一些作者对其预后价值提出了质疑。对于CA-125阈值为500 UI/L，敏感性、特异性、阳性和阴性预测值分别为58%至78%、64%至89%、64%至84%和35.7%至85.4%。影像学标准未能得出一致结果。实际上，敏感性、特异性、阳性和阴性预测值分别在52%至100%、75%至100%、49%至100%和50%至100%之间变化。评估疾病播散的癌病评分已证明具有高度相关性（ROC曲线的AUC高于0.6）。在开腹手术中，对于Eisenkop评分低于6分的患者，99%能够从完全切除中获益。在腹腔镜手术中，对于Fagotti评分低于4分的患者，78%能够实现完全减瘤。该评分具有最佳的AUC（0.76）。有多种评分系统可供外科医生评估晚期卵巢癌的可切除性。其中，术中评分系统似乎是最佳工具，尤其在首次腹腔镜手术时应在常规操作中推荐使用。最后，由于初次完全切除对生存有影响，晚期卵巢癌女性患者应转诊至专业中心。
