Ovarian Cancer Program, Department of Gynecologic Oncology, Fudan University Cancer Hospital, Shanghai, China.
Eur J Surg Oncol. 2013 Jul;39(7):786-91. doi: 10.1016/j.ejso.2013.02.006. Epub 2013 Mar 13.
To evaluate the outcomes and patterns of patients with secondary relapsed ovarian cancer.
A retrospective study was conducted. The cases comprised 83 patients who underwent tertiary cytoreductive surgery (TCS) followed by chemotherapy, whereas the controls consisted of 76 patients who received chemotherapy alone.
The median survival was 20 months in 159 patients. Patients with microscopic residual disease after TCS had a median survival of 32.9 months compared with 14.6 months in those with macroscopic residual disease [hazard ratio (HR), 2.82; P = 0.001) and 15.0 months in patients with chemotherapy alone (HR, 2.23; P = 0.001). When stratified by a progression-free interval (PFI) after secondary cytoreduction (SCR), TCS showed no benefit in patients with a PFI ≤12 months or a PFI >12 months compared with those with chemotherapy alone. TCS improved survival in patients with recurrent disease in the pelvis compared with those with recurrent disease in the middle or upper abdomen, with a median survival of 34.9 months and 14.6 months, respectively (HR, 2.94; P = 0.010). However, TCS was not a survival determinant by multivariate analysis. A multivariate analysis identified a PFI after SCR (≤12 mos vs. >12 mos; HR, 2.34; 95% CI, 1.29-4.24; P = 0.005), mesenteric lymph node metastasis at SCR (yes vs. no; HR, 4.18; 95% CI, 1.93-9.03; P < 0.001) and treatment arms at secondary relapse (chemotherapy alone vs. TCS; HR, 1.56; 95% CI, 1.03-2.38; P = 0.037) as independent predictors of survival.
Limited survival benefit from tertiary cytoreductive surgery was observed in patients with platinum-sensitive secondary relapsed ovarian cancer.
评估二次复发性卵巢癌患者的结局和模式。
进行了一项回顾性研究。该病例包括 83 例接受三次细胞减灭术（TCS）后化疗的患者，对照组包括 76 例仅接受化疗的患者。
159 例患者的中位生存期为 20 个月。TCS 后显微镜下有残留病灶的患者中位生存期为 32.9 个月，而宏观残留病灶患者为 14.6 个月[风险比（HR），2.82；P = 0.001]，与单独化疗患者的 15.0 个月相比[HR，2.23；P = 0.001]。根据二次细胞减灭术（SCR）后无进展间隔时间（PFI）分层，与单独化疗相比，TCS 对 PFI≤12 个月或 PFI>12 个月的患者无获益。与中腹或上腹复发性疾病患者相比，TCS 改善了盆腔复发性疾病患者的生存，中位生存期分别为 34.9 个月和 14.6 个月[HR，2.94；P = 0.010]。然而，多因素分析并未将 TCS 确定为生存决定因素。多因素分析确定了 SCR 后的 PFI（≤12 个月 vs. >12 个月；HR，2.34；95%CI，1.29-4.24；P = 0.005）、SCR 时肠系膜淋巴结转移（是 vs. 否；HR，4.18；95%CI，1.93-9.03；P < 0.001）和二次复发时的治疗方法（单独化疗 vs. TCS；HR，1.56；95%CI，1.03-2.38；P = 0.037）是生存的独立预测因素。
铂敏感的二次复发性卵巢癌患者接受三次细胞减灭术的生存获益有限。
