Department of Gynecology and Obstetrics, University of Duisburg-Essen, Essen, Germany.
Ann Surg Oncol. 2010 Jun;17(6):1642-8. doi: 10.1245/s10434-010-0964-9. Epub 2010 Feb 18.
One of the most important prognostic factors in advanced ovarian cancer is the macroscopic absence of residual tumor after primary surgery. The impact of surgical outcome on the survival of patients with International Federation of Gynecology and Obstetrics (FIGO) stage IV disease is less clear and is the subject of this study.
Surgical and survival data were documented throughout the multicenter prospective randomized phase III trials of the AGO-OVAR (OVAR-3/-5/-7) and were used for this exploratory analysis. In these studies, 573 patients with FIGO stage IV disease were first operated, then randomized and homogenously treated with a combination therapy comprising the intravenous application of platinum and paclitaxel.
The median progression-free survival and overall survival of patients with stage IV ovarian cancer were 12.6 and 26.1 months, respectively. Multivariable Cox regression analysis for overall survival revealed that residual tumor, mucinous histological type, multiple sites of metastases, and Eastern Cooperative Oncology Group performance status were statistically significant prognostic variables. Whereas patients with macroscopically complete resection had a statistically significant improved outcome, patients with residual disease of 0.1-1 cm and patients with residual tumor of >1 cm showed similar outcome.
Macroscopically complete resection in FIGO stage IV disease, irrespective of the site of distant tumor spread, is an important prognostic factor and the only prognosticator amenable to improvement by therapy. Our results suggest possible advantages of a reasonable attempt at complete cytoreduction even in FIGO stage IV disease. In addition, tumor biology could be an important factor for achieving complete resection.
在晚期卵巢癌中，最重要的预后因素之一是初次手术后宏观上无残留肿瘤。手术结果对国际妇产科联合会（FIGO）分期为 IV 期疾病患者的生存影响尚不清楚，这也是本研究的主题。
在 AGO-OVAR（OVAR-3/-5/-7）多中心前瞻性随机 III 期试验中记录了手术和生存数据，并将其用于此探索性分析。在这些研究中，573 名 FIGO 分期为 IV 期的患者首先进行了手术，然后随机分组，并接受包含静脉应用铂类和紫杉醇的联合治疗进行均质治疗。
IV 期卵巢癌患者的中位无进展生存期和总生存期分别为 12.6 个月和 26.1 个月。总生存期的多变量 Cox 回归分析显示，残留肿瘤、黏液组织学类型、多处转移部位和东部合作肿瘤学组表现状态是具有统计学意义的预后变量。虽然宏观上完全切除的患者具有统计学上显著改善的结果，但残留肿瘤为 0.1-1cm 的患者和残留肿瘤>1cm 的患者具有相似的结果。
FIGO 分期为 IV 期疾病的宏观完全切除，无论远处肿瘤扩散的部位如何，都是一个重要的预后因素，也是唯一可通过治疗改善的预后因素。我们的结果表明，即使在 FIGO 分期为 IV 期疾病中，进行合理的完全减瘤术可能具有优势。此外，肿瘤生物学可能是实现完全切除的一个重要因素。
