Division General Gynaecology and Gynaecological Oncology, Department of Obstetrics and Gynaecology, Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria.
Int J Gynecol Cancer. 2012 Mar;22(3):380-5. doi: 10.1097/IGC.0b013e31823de6ae.
The objective of the study was to evaluate the prognostic impact of residual tumor size after cytoreductive surgery in patients with epithelial ovarian cancer.
In this prospective, multicenter study, 226 patients with epithelial ovarian cancer (International Federation of Gynecology and Obstetrics stages IIA-IV) were included. Patients were treated with cytoreductive surgery and adjuvant platinum-based chemotherapy. Univariate and multivariable survival analyses were performed to investigate the impact of residual tumor size on progression-free and overall survival.
In 69.4% of patients, surgery resulted in complete tumor resection; minimal residual disease (≤1 cm) was achieved in 87.2% of patients. Advanced tumor stage was associated with a lower rate of complete tumor resection (P < 0.001). After cytoreductive surgery, 3-year overall survival rates were 72.4%, 65.8%, and 45.2% for patients without, with minimal, and with gross residual disease (>1 cm), respectively (P < 0.001). Multivariable survival analysis revealed residual tumor size (P = 0.04) and older patient age (P = 0.02) as independent prognosticators for impaired overall survival. Complete cytoreduction was predictive for a higher rate of treatment response (P = 0.001) and was associated with prolonged progression-free and overall survival (P < 0.001 and P = 0.001).
The size of residual disease after cytoreduction is one of the most crucial prognostic factors for patients with ovarian cancer. Patients after complete cytoreduction have a superior outcome compared with patients with residual disease. Leaving no residual tumor has to be the aim of primary surgery for ovarian cancer; therefore, patients should receive treatment at centers able to undertake complex cytoreductive procedures.
本研究旨在评估卵巢上皮癌患者细胞减灭术后残余肿瘤大小的预后影响。
在这项前瞻性、多中心研究中，纳入了 226 名上皮性卵巢癌（国际妇产科联合会分期 IIA-IV 期）患者。患者接受细胞减灭术和辅助铂类化疗。进行单变量和多变量生存分析，以研究残余肿瘤大小对无进展生存和总生存的影响。
在 69.4%的患者中，手术实现了完全肿瘤切除；87.2%的患者达到了最小残余疾病（≤1cm）。晚期肿瘤分期与完全肿瘤切除率降低相关（P<0.001）。细胞减灭术后，无残余肿瘤、微小残余肿瘤（>1cm）和明显残余肿瘤（>1cm）患者的 3 年总生存率分别为 72.4%、65.8%和 45.2%（P<0.001）。多变量生存分析显示，残余肿瘤大小（P=0.04）和老年患者年龄（P=0.02）是总生存受损的独立预后因素。完全细胞减灭术可预测更高的治疗反应率（P=0.001），并与无进展生存和总生存延长相关（P<0.001 和 P=0.001）。
细胞减灭术后残余疾病的大小是卵巢癌患者最重要的预后因素之一。完全细胞减灭术后的患者预后优于有残余疾病的患者。手术的目标必须是尽可能切除所有肿瘤，因此患者应在能够进行复杂细胞减灭术的中心接受治疗。
