根治性细胞减灭术对晚期卵巢癌化疗的省略和延迟的影响。
Effect of radical cytoreductive surgery on omission and delay of chemotherapy for advanced-stage ovarian cancer.
机构信息
Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, Mailman School of Public Health, and the Herbert Irving Comprehensive Cancer Center, New York, New York 10032, USA.
出版信息
Obstet Gynecol. 2012 Oct;120(4):871-81. doi: 10.1097/AOG.0b013e31826981de.
OBJECTIVE
Cytoreductive surgery is associated with extensive morbidity and may delay chemotherapy. We examined the associations among cytoreduction, perioperative complications, and delay or omission of chemotherapy.
METHODS
Women aged 65 years or older with stage III-IV ovarian cancer who were treated with surgery from 1991-2005 and recorded in the Surveillance, Epidemiology, and End Results-Medicare database were examined. We estimated the influence of extended cytoreduction as well as the occurrence of major perioperative complications on receipt and timing of chemotherapy and survival.
RESULTS
Among 3,991 patients, 479 (12%) failed to receive chemotherapy. Of those treated with chemotherapy, 2,527 (72%) initiated treatment within 6 weeks of surgery, 838 (24%) within 6-12 weeks, and 147 (4%) more than 12 weeks after surgery. In a multivariable model, older patients, those with comorbidities, mucinous tumors, and stage IV neoplasms were more likely not to receive chemotherapy (P<.05). Extended cytoreduction and the occurrence of postoperative complications were not associated with omission of chemotherapy but were associated with chemotherapy delay. For every 14 patients who underwent one extended procedure and for every 13 who had two extended procedures, one patient had a delay in receipt of chemotherapy. For every 14 patients who had one complication and for every four who had two complications, one patient had a delay in receipt of chemotherapy. The occurrence of more than two perioperative complications (hazard ratio 1.31, 95% confidence interval [CI] 1.15-1.49) and initiation of chemotherapy more than 12 weeks after surgery (hazard ratio 1.32, 95% CI 1.07-1.64) were associated with decreased survival.
CONCLUSION
Extended cytoreductive surgery and perioperative complications significantly delay initiation but do not increase the chance of omission of chemotherapy for women with ovarian cancer.
LEVEL OF EVIDENCE
II.
目的
细胞减灭术与广泛的发病率相关，且可能会延迟化疗的开始时间。我们检验了细胞减灭术、围手术期并发症与化疗的延迟或遗漏之间的关联。
方法
我们对在 1991 年至 2005 年期间接受手术且记录在监测、流行病学和最终结果-医疗保险数据库中的年龄在 65 岁及以上的 III-IV 期卵巢癌女性患者进行了检查。我们评估了广泛的细胞减灭术的影响以及主要围手术期并发症的发生对接受化疗和开始化疗的时间以及生存的影响。
结果
在 3991 例患者中，有 479 例（12%）未接受化疗。在接受化疗的患者中，有 2527 例（72%）在手术后 6 周内开始治疗，有 838 例（24%）在 6-12 周内开始治疗，有 147 例（4%）在手术后超过 12 周才开始治疗。在多变量模型中，年龄较大、合并症较多、黏液性肿瘤和 IV 期肿瘤的患者更不可能接受化疗（P<.05）。广泛的细胞减灭术和术后并发症的发生与化疗的遗漏无关，但与化疗的延迟有关。每进行一次扩展手术，就会有一名患者化疗延迟；每进行两次扩展手术，就会有一名患者化疗延迟。每发生一次并发症，就会有一名患者化疗延迟；每发生两次并发症，就会有一名患者化疗延迟。超过两次围手术期并发症（风险比 1.31，95%置信区间 [CI] 1.15-1.49）和术后 12 周以上开始化疗（风险比 1.32，95% CI 1.07-1.64）与生存时间缩短相关。
结论
对于卵巢癌患者，广泛的细胞减灭术和围手术期并发症会显著延迟化疗的开始时间，但并不会增加化疗遗漏的机会。
证据水平
II 级。
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