Department of Procreative Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy.
Gynecol Oncol. 2010 Mar;116(3):358-63. doi: 10.1016/j.ygyno.2009.11.008. Epub 2009 Dec 1.
To assess the clinical outcome of epithelial ovarian cancer patients who developed an apparently isolated lymph node recurrence after primary therapy.
The authors retrospectively assessed 69 patients with epithelial ovarian cancer who were clinically or pathologically free of disease after primary therapy and who subsequently developed an apparently isolated lymph node recurrence. The median follow-up of survivors was 74.5 months.
Median age was 58 years, FIGO stage was III-IV in 52 (75%) patients, residual disease after primary surgery was >1 cm in 36 (52%), first-line chemotherapy consisted of paclitaxel-/platinum-based chemotherapy in 44 (64%), time to recurrence was >12 months in 43 (62%), recurrence was pelvic and/or para-aortic in 41 (59%), and treatment at recurrence consisted of chemotherapy alone in 44 (64%), surgery plus chemotherapy in 22 (32%), surgery alone in one patient, surgery plus irradiation in one, and irradiation alone in one patient. Survival after recurrence was significantly related to the type of treatment (chemotherapy alone versus surgery plus chemotherapy, median: 20.8 months versus not reached, p=0.0002), and patient age (>58 versus <58 years, median: 26.8 versus 44.0 months, p=0.02). Overall survival was significantly related to the type of treatment (chemotherapy alone versus surgery plus chemotherapy, median: 45.4 months versus not reached, p=0.0001), patient age (>58 versus <58 years, median: 45.4 versus 62.9 months, p=0.03) and time to recurrence (<12 months versus >12 months, median: 45.4 versus 66.9 months, p=0.01). Cox model showed that treatment at recurrence was the strongest independent prognostic variable for both survival after recurrence (hazard ratio [HR]=0.277, p=0.0003) and overall survival (HR=0.249, p=0.0002).
Patients who underwent surgery plus chemotherapy had a 72% reduction in the risk of death after recurrence and a 75% reduction in the risk of death after initial diagnosis when compared with those treated with chemotherapy alone. Secondary cytoreductive surgery appears to be able to prolong survival in epithelial ovarian cancer patients with apparently isolated lymph node recurrence.
评估原发性治疗后出现孤立性淋巴结复发的上皮性卵巢癌患者的临床结局。
作者回顾性评估了 69 例上皮性卵巢癌患者，这些患者在原发性治疗后临床或病理上无疾病，并随后出现孤立性淋巴结复发。幸存者的中位随访时间为 74.5 个月。
中位年龄为 58 岁，FIGO 分期为 III-IV 期的患者为 52 例（75%），初次手术残余病灶>1cm 的患者为 36 例（52%），一线化疗方案为紫杉醇/铂类化疗的患者为 44 例（64%），复发时间>12 个月的患者为 43 例（62%），复发为盆腔和/或腹主动脉旁的患者为 41 例（59%），复发时治疗方法为单纯化疗的患者为 44 例（64%），手术联合化疗的患者为 22 例（32%），单纯手术的患者为 1 例，手术联合放疗的患者为 1 例，单纯放疗的患者为 1 例。复发后的生存与治疗类型显著相关（单纯化疗与手术联合化疗，中位：20.8 个月与未达到，p=0.0002），与患者年龄（>58 岁与<58 岁，中位：26.8 个月与 44.0 个月，p=0.02）。总生存与治疗类型显著相关（单纯化疗与手术联合化疗，中位：45.4 个月与未达到，p=0.0001），与患者年龄（>58 岁与<58 岁，中位：45.4 个月与 62.9 个月，p=0.03）和复发时间（<12 个月与>12 个月，中位：45.4 个月与 66.9 个月，p=0.01）。Cox 模型显示，复发时的治疗是复发后生存（风险比[HR]=0.277，p=0.0003）和总生存（HR=0.249，p=0.0002）的最强独立预后因素。
与单纯化疗相比，手术联合化疗可使上皮性卵巢癌患者的复发后死亡风险降低 72%，初始诊断后死亡风险降低 75%。二次细胞减灭术似乎能够延长上皮性卵巢癌孤立性淋巴结复发患者的生存。
