Marsoni S, Torri V, Valsecchi M G, Belloni C, Bianchi U, Bolis G, Bonazzi C, Colombo N, Epis A, Favalli G
Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy.
Br J Cancer. 1990 Sep;62(3):444-50. doi: 10.1038/bjc.1990.315.
The data on 914 patients enrolled in four randomised trials in advanced ovarian cancer, consecutively conducted by the same cooperative group between 1978 and 1986, were analysed with the aims of: (1) determining the impact of selected prognostic variables on survival; (2) finding, from the interaction of favourable prognostic factors and treatment, an approximate estimate of the magnitude of the survival advantage associated with the use of platinum-based combination chemotherapy. The overall 3-year survival in this series of patients is twice that reported historically (22%; 95% CL 18.7-25.4). The proportional hazard regression model was used to perform the analysis on survival. Residual tumour size, age, FIGO stage and cell type were all independent determinants of survival. Differences in survival from the various prognostic groups were impressive with 5-year survival rates ranging from 7 to 62%. However, these differences were not qualitative (i.e. the kinetics of survival were similar for the best and the worst groups) suggesting that current prognostic factors are of little use for selecting 'biologically' different sub-populations. Platinum-based regimens were associated to an overall prolonged median survival, but this benefit was not observable in the subgroup with most favourable prognosis (less than 2 cm residual tumour size). The implications of these observations for clinical research and ovarian cancer patients care are discussed.
对1978年至1986年间由同一合作组连续开展的四项晚期卵巢癌随机试验中纳入的914例患者的数据进行了分析，目的如下：(1)确定所选预后变量对生存的影响；(2)从有利预后因素与治疗的相互作用中，大致估计与使用铂类联合化疗相关的生存优势幅度。该系列患者的总体3年生存率是历史报道的两倍(22%；95%置信区间18.7 - 25.4)。使用比例风险回归模型对生存进行分析。残余肿瘤大小、年龄、国际妇产科联盟(FIGO)分期和细胞类型均为生存的独立决定因素。不同预后组的生存差异令人印象深刻，5年生存率在7%至62%之间。然而，这些差异并非质性差异(即最佳和最差组的生存动力学相似)，这表明目前的预后因素对于选择“生物学上”不同的亚组几乎没有用处。铂类方案与总体中位生存期延长相关，但在预后最有利的亚组(残余肿瘤大小小于2 cm)中未观察到这种益处。讨论了这些观察结果对临床研究和卵巢癌患者护理的意义。
