Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, Division of Gynecologic Oncology, San Francisco School of Medicine, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA 94143-1702, USA.
Gynecol Oncol. 2010 Mar;116(3):307-11. doi: 10.1016/j.ygyno.2009.10.074. Epub 2009 Nov 27.
This study aimed to evaluate the clinical outcome of recurrent early-stage high-risk epithelial ovarian cancer patients.
Demographic and clinicopathological data were collected from women enrolled in GOG 157 who underwent surgical staging and had recurrent disease. Survival probability was estimated using Kaplan-Meier method, and hazard ratio of death was analyzed using Cox regression model.
Of 74 women with recurrent early-stage high-risk ovarian cancer, the median age at recurrence was 63 years; 93% were White, 2.7% were Black, 2.7% were Asian, and 1.4% were Others. Fifty-eight percent had stage I, and the remainder had stage II disease. Clear cell, serous, endometrioid, mucinous, and other tumors consisted of 28.4%, 25.7%, 24.3%, 16.2%, and 5.4% of patients, respectively; in addition, 36.5% had ascites, 33.8% had positive cytology, and 43.2% had ruptured tumors. Fifty-eight percent underwent three cycles, and 42% had six cycles of adjuvant chemotherapy with paclitaxel and carboplatin. Recurrence was diagnosed clinically in 46% and radiographically in 54% of women. The median time from completion of primary chemotherapy to recurrence (treatment-free interval, TFI) was 21 months. Overall, median survival after recurrence was 24 months. Patients with longer (>24 months) TFI had a higher median survival after subsequent treatment at 35 months compared to only 10 months in those who recurred <or=24 months (p=0.003).
Although patients with primary early-stage high-risk ovarian cancer have an overall favorable prognosis, survival after recurrence is poor and comparable to those with recurrent advanced-stage disease. Novel therapeutic modalities are warranted in these high-risk patients.
本研究旨在评估复发性早期高危上皮性卵巢癌患者的临床结局。
从接受手术分期且疾病复发的 GOG 157 入组女性中收集人口统计学和临床病理学数据。使用 Kaplan-Meier 方法估计生存概率，并使用 Cox 回归模型分析死亡的危险比。
在 74 例复发性早期高危卵巢癌患者中，中位复发年龄为 63 岁；93%为白人，2.7%为黑人，2.7%为亚洲人，1.4%为其他人。58%为 I 期，其余为 II 期疾病。透明细胞癌、浆液性癌、子宫内膜样癌、黏液性癌和其他肿瘤分别占患者的 28.4%、25.7%、24.3%、16.2%和 5.4%；此外，36.5%有腹水，33.8%有阳性细胞学，43.2%有肿瘤破裂。58%的患者接受了 3 个周期，42%的患者接受了 6 个周期的紫杉醇联合卡铂辅助化疗。46%的女性通过临床诊断，54%的女性通过影像学诊断复发。从完成原发性化疗到复发（无治疗间隔，TFI）的中位时间为 21 个月。总体而言，复发后中位生存时间为 24 个月。TFI>24 个月的患者在随后治疗后的中位生存时间为 35 个月，而 TFI≤24 个月的患者仅为 10 个月（p=0.003）。
尽管原发性早期高危卵巢癌患者总体预后良好，但复发后的生存情况较差，与复发性晚期疾病相当。这些高危患者需要新的治疗方法。
