原发性与间隔性肿瘤细胞减灭术治疗晚期卵巢癌的疗效比较：一项系统的单中心分析结果。
Primary versus interval debulking surgery in advanced ovarian cancer: results from a systematic single-center analysis.
机构信息
Department of Gynecology, Charité, Campus Virchow Clinic/University Hospital, Augustenburger Platz 1, Berlin, Germany.
出版信息
Int J Gynecol Cancer. 2010 Nov;20(8):1331-40. doi: 10.1111/IGC.0b013e3181f15714.
OBJECTIVE
To evaluate the difference in operative and clinical outcome for patients with primary advanced ovarian cancer (AOC) after optimal primary debulking surgery (PDS) versus interval debulking surgery (IDS).
METHODS
Tumor dissemination pattern and surgical outcome, as defined by morbidity, progression-free (PFS) survival and overall survival (OS) were systematically analyzed in AOC patients who underwent surgery in our institution between September 2000 and August 2009. Overall survival and PFS were calculated by Kaplan-Meier curves. Univariate and Cox regression analysis were performed to identify the impact of IDS on surgical outcome and survival.
RESULTS
Overall, 372 consecutive patients with histologically proven AOC (FIGO [International Federation of Gynecology and Obstetrics] stage III/IV) were evaluated. Forty patients (10.8%) underwent IDS after a median of 5 cycles (range, 2-6 cycles) platinum- and taxane-based chemotherapy, and 332 patients (89.2%) underwent PDS. Patients who underwent IDS had a significantly lower rate of tumor involvement of the lower (78.9% vs 98.8%; P < 0.001) and middle abdomen (68.4% vs 83.1%; P = 0.044) compared with PDS patients. During IDS, a significantly higher probability for complete tumor resection occurred when compared with PDS (85% vs 58.7%; P = 0.02) by equivalent rates of operative complications (36.4% vs 36.5%; P = 1.00). However, mean PFS was significantly reduced in IDS patients (14.6 vs 33.2 months; P < 0.001). Mean OS was also higher in PDS patients, but this reached a statistical significance only when complete tumor resection was obtained (65.4 vs 37.9 months; P = 0.005). Multivariate analysis identified that IDS was associated with an unfavorable OS and PFS.
CONCLUSIONS
: It seems that PDS has a more favorable outcome than IDS on both OS and PFS in AOC patients, even though IDS leads to significantly higher rates of complete tumor resection.
目的
评估原发性晚期卵巢癌（AOC）患者在接受最佳初始肿瘤细胞减灭术（PDS）与间隔肿瘤细胞减灭术（IDS）后的手术和临床结局差异。
方法
系统分析 2000 年 9 月至 2009 年 8 月期间在我院接受手术的 AOC 患者的肿瘤播散模式和手术结果，定义为发病率、无进展生存期（PFS）和总生存期（OS）。通过 Kaplan-Meier 曲线计算总生存期和 PFS。进行单变量和 Cox 回归分析以确定 IDS 对手术结局和生存的影响。
结果
共有 372 名经组织学证实的 AOC（FIGO [国际妇产科联合会] III/IV 期）连续患者接受了评估。40 名患者（10.8%）在中位数为 5 个周期（范围为 2-6 个周期）的铂类和紫杉烷类化疗后接受了 IDS，332 名患者（89.2%）接受了 PDS。与 PDS 患者相比，接受 IDS 的患者下腹部（78.9% vs 98.8%；P < 0.001）和中腹部（68.4% vs 83.1%；P = 0.044）肿瘤受累的发生率明显较低。在 IDS 中，与 PDS 相比，完全肿瘤切除的可能性明显更高（85% vs 58.7%；P = 0.02），手术并发症的发生率相当（36.4% vs 36.5%；P = 1.00）。然而，IDS 患者的平均 PFS 明显缩短（14.6 与 33.2 个月；P < 0.001）。PDS 患者的平均 OS 也较高，但仅当获得完全肿瘤切除时才有统计学意义（65.4 与 37.9 个月；P = 0.005）。多变量分析表明，IDS 与不利的 OS 和 PFS 相关。
结论
即使 IDS 导致更高比例的完全肿瘤切除，但在 AOC 患者中，PDS 在 OS 和 PFS 方面似乎比 IDS 具有更有利的结果。
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