Marszalek Anne, Alran Séverine, Scholl Suzy, Fourchotte Virginie, Plancher Corinne, Rosty Christophe, Meyniel Jean Philippe, De Margerie Vincent, Dorval Thierry, De La Rochefordière Anne, Cottu Paul, Petrow Peter, Sastre-Garrau Xavier, Salmon Rémy Jacques
Department of Surgery, Institut Curie, 25 rue d'Ulm, 75005 Paris, France.
Int J Surg Oncol. 2010;2010:214919. doi: 10.1155/2010/214919. Epub 2010 Jul 25.
Objectives. The purpose of this retrospective evaluation of advanced-stage ovarian cancer patients was to compare outcome with published findings from other centers and to discuss future options for the management of advanced ovarian carcinoma patients. Methods. A retrospective series of 340 patients with a mean age of 58 years (range: 17-88) treated for FIGO stage III and IV ovarian cancer between January 1985 and January 2005 was reviewed. All patients had primary cytoreductive surgery, without extensive bowel, peritoneal, or systematic lymph node resection, thereby allowing initiation of chemotherapy without delay. Chemotherapy consisted of cisplatin-based chemotherapy in combination with alkylating agents before 2000, whereas carboplatin and paclitaxel regimes were generally used after 1999-2000. Overall survival and disease-free survival were analyzed by the Kaplan-Meier method and the log-rank test. Results. With a mean followup of 101 months (range: 5 to 203), 280 events (recurrence or death) were observed and 245 patients (72%) had died. The mortality and morbidity related to surgery were low. The main prognostic factor for overall survival was postoperative residual disease (P < .0002), while the main prognostic factor for disease-free survival was histological tumor type (P < .0007). Multivariate analysis identified three significant risk factors: optimal surgery (RR = 2.2 for suboptimal surgery), menopausal status (RR = 1.47 for postmenopausal women), and presence of a taxane in the chemotherapy combination (RR = 0.72). Conclusion. These results confirm that optimal surgery defined by an appropriate and comprehensive effort at upfront cytoreduction limits morbidity related to the surgical procedure and allows initiation of chemotherapy without any negative impact on survival. The impact of neoadjuvant chemotherapy to improve resectability while lowering the morbidity of the surgical procedure is discussed.
目的。本次对晚期卵巢癌患者的回顾性评估旨在将结果与其他中心已发表的研究结果进行比较，并探讨晚期卵巢癌患者未来的治疗选择。方法。回顾了1985年1月至2005年1月期间接受治疗的340例平均年龄58岁（范围：17 - 88岁）的FIGO III期和IV期卵巢癌患者。所有患者均接受了初次肿瘤细胞减灭术，未进行广泛的肠道、腹膜或系统性淋巴结切除，从而能够立即开始化疗。2000年前化疗采用以顺铂为基础的化疗联合烷化剂，而1999 - 2000年后一般采用卡铂和紫杉醇方案。采用Kaplan - Meier法和对数秩检验分析总生存期和无病生存期。结果。平均随访101个月（范围：5至203个月），观察到280例事件（复发或死亡），245例患者（72%）死亡。与手术相关的死亡率和发病率较低。总生存期的主要预后因素是术后残留病灶（P < 0.0002），而无病生存期的主要预后因素是组织学肿瘤类型（P < 0.0007）。多因素分析确定了三个显著危险因素：最佳手术（次优手术的RR = 2.2）、绝经状态（绝经后女性的RR = 1.47）以及化疗方案中紫杉烷的使用（RR = 0.72）。结论。这些结果证实，通过适当且全面的初次肿瘤细胞减灭术所定义的最佳手术可限制与手术相关的发病率，并允许开始化疗而不对生存产生任何负面影响。讨论了新辅助化疗在提高可切除性同时降低手术发病率方面的作用。
