Altman Alon D, Nelson Gregg, Chu Pamela, Nation Jill, Ghatage Prafull
Winnipeg Health Sciences Centre and Cancercare Manitoba, University of Manitoba, Winnipeg MB.
Tom Baker Cancer Centre and Foothills Medical Centre, University of Calgary, Calgary AB.
J Obstet Gynaecol Can. 2012 Jun;34(6):558-566. doi: 10.1016/S1701-2163(16)35272-0.
The objective of this study was to examine both overall and disease-free survival of patients with advanced stage ovarian cancer after immediate or interval debulking surgery based on residual disease.
We performed a retrospective chart review at the Tom Baker Cancer Centre in Calgary, Alberta of patients with pathologically confirmed stage III or IV ovarian cancer, fallopian tube cancer, or primary peritoneal cancer between 2003 and 2007. We collected data on the dates of diagnosis, recurrence, and death; cancer stage and grade, patients' age, surgery performed, and residual disease.
One hundred ninety-two patients were included in the final analysis. The optimal debulking rate with immediate surgery was 64.8%, and with interval surgery it was 85.9%. There were improved overall and disease-free survival rates for optimally debulked disease (< 1 cm) with both immediate and interval surgery (P < 0.001) compared to suboptimally debulked disease. Overall survival rates for optimally debulked disease were not significantly different in patients having immediate and interval surgery (P = 0.25). In the immediate surgery group, patients with microscopic residual disease had better disease-free survival (P = 0.015) and overall survival (P = 0.005) than patients with < 1 cm residual disease. In patients who had interval surgery, those who had microscopic residual disease had more improved disease-free survival than those with < 1 cm disease (P = 0.05), but they did not have more improved overall survival (P = 0.42). Patients with microscopic residual disease who had immediate surgery had a significantly better overall survival rate than those who had interval surgery (P = 0.034).
In women with advanced stage ovarian cancer, the goal of surgery should be resection of disease to microscopic residual at the initial procedure. This results in improved overall survival than lesser degrees of resection. Further studies are required to determine optimal surgical management.
本研究的目的是根据残留病灶情况，研究晚期卵巢癌患者在即刻减瘤手术或间隔减瘤手术后的总生存期和无病生存期。
我们对艾伯塔省卡尔加里市汤姆·贝克癌症中心2003年至2007年间病理确诊为III期或IV期卵巢癌、输卵管癌或原发性腹膜癌的患者进行了回顾性病历审查。我们收集了诊断、复发和死亡日期；癌症分期和分级、患者年龄、所进行的手术以及残留病灶的数据。
192例患者纳入最终分析。即刻手术的最佳减瘤率为64.8%，间隔手术的最佳减瘤率为85.9%。与减瘤不充分的疾病相比，即刻手术和间隔手术治疗减瘤充分（<1 cm）的疾病，其总生存期和无病生存期均有所改善（P<0.001）。减瘤充分的疾病的总生存率在即刻手术和间隔手术的患者中无显著差异（P = 0.25）。在即刻手术组中，微小残留病灶患者的无病生存期（P = 0.015）和总生存期（P = 0.005）均优于残留病灶<1 cm的患者。在接受间隔手术的患者中，微小残留病灶患者的无病生存期改善程度高于残留病灶<1 cm的患者（P = 0.05），但总生存期改善程度无差异（P = 0.42）。接受即刻手术的微小残留病灶患者的总生存率显著高于接受间隔手术的患者（P = 0.034）。
对于晚期卵巢癌女性患者，手术目标应为在初次手术时将病灶切除至微小残留。这比切除程度较低能提高总生存率。需要进一步研究以确定最佳手术管理方案。
