Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA.
Gynecol Oncol. 2011 Sep;122(3):521-6. doi: 10.1016/j.ygyno.2011.04.041. Epub 2011 Jun 17.
To assess the survival impact of initial disease distribution on patients with stage III epithelial ovarian cancer (EOC) cytoreduced to microscopic residual.
We reviewed data from 417 stage III EOC patients cytoreduced to microscopic disease and given adjuvant intravenous platinum/paclitaxel on one of three randomized Gynecologic Oncology Group (GOG) trials. We subdivided patients into three groups based on preoperative disease burden: (1) minimal disease (MD) defined by pelvic tumor and retroperitoneal metastasis (2) abdominal peritoneal disease (APD) with disease limited to the pelvis, retroperitoneum, lower abdomen and omentum; and (3) upper abdominal disease (UAD) with disease affecting the diaphragm, spleen, liver or pancreas. We assessed the survival impact of potential prognostic factors, focusing on initial disease distribution using a proportional hazards model and estimated Kaplan-Meier survival curves.
The study groups had similar clinicopathologic characteristics. Median overall survival (OS) was not reached in MD patients compared to 80 and 56 months in the APD and UAD groups (P<0.05). The five-year survival percentages for MD, APD, and UAD were 67%, 63%, and 45%. In multivariate analysis, the UAD group had a significantly worse prognosis than MD and APD both individually and combined (Progression Free Survival (PFS) Hazards Ratio (HR) 1.44; P=0.008 and OS HR 1.77; P=0.0004 compared to MD+APD).
Stage III EOC patients with initial disease in the upper abdomen have a worse prognosis despite cytoreductive surgery to microscopic residual implying that factors beyond cytoreductive effort are important in predicting survival.
评估初始疾病分布对减瘤至显微镜下残留的 III 期上皮性卵巢癌（EOC）患者生存的影响。
我们回顾了在 3 项随机妇科肿瘤学组（GOG）试验中接受静脉注射顺铂/紫杉醇辅助治疗的 417 例减瘤至显微镜下残留的 III 期 EOC 患者的数据。我们根据术前疾病负担将患者分为 3 组：（1）最小疾病（MD）定义为盆腔肿瘤和腹膜后转移；（2）仅累及盆腔、腹膜后、下腹和大网膜的腹腔疾病（APD）；（3）累及膈肌、脾脏、肝脏或胰腺的上腹部疾病（UAD）。我们使用比例风险模型评估潜在预后因素对生存的影响，重点关注初始疾病分布，并估计 Kaplan-Meier 生存曲线。
研究组具有相似的临床病理特征。MD 患者的中位总生存期（OS）未达到，而 APD 和 UAD 组分别为 80 和 56 个月（P<0.05）。MD、APD 和 UAD 组的 5 年生存率分别为 67%、63%和 45%。多因素分析显示，UAD 组与 MD 和 APD 组相比，无论是单独比较还是联合比较，预后均较差（无进展生存期（PFS）风险比（HR）1.44；P=0.008 和 OS HR 1.77；P=0.0004）。
尽管进行了减瘤至显微镜下残留的手术，但初始疾病位于上腹部的 III 期 EOC 患者预后较差，这表明除减瘤努力以外的因素对预测生存至关重要。
