Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Gynecol Oncol. 2013 Sep;130(3):487-92. doi: 10.1016/j.ygyno.2013.06.017. Epub 2013 Jun 17.
To examine the utility of upper abdominal procedures (UAPs) performed in a cohort of optimally cytoreduced patients with advanced stage epithelial ovarian cancer (EOC) or primary peritoneal cancer (PPC) and identify potential areas where aggressive surgery may impact survival.
We reviewed 2655 patients enrolled in Gynecologic Oncology Group (GOG) 182 who had complete resection (CR) or minimal residual (MR) disease <1cm. Demographic, pathologic, surgical, and outcome data were collected. UAPs included diaphragm stripping or resection, liver resection, splenectomy, pancreatectomy, and porta hepatis surgery. Effect of UAP and CR on PFS/OS was assessed by Kaplan-Meier and proportional hazards methods.
Four-hundred eighty-two patients (18.1%) underwent a total of 590 UAPs. There were 351 (13.1%) diaphragm surgeries, 112 (4.2%) liver surgeries, 108 (4%) splenectomies, 12 (0.5%) pancreatectomies, and 7 (0.2%) porta hepatis surgeries. Comparing patients who did not have UAPs to patients who had UAPs, the PFS was 18.2 months (mos) and 14.8 mos (p < 0.01) and OS was 49.8 mos v. 43.7 mos (p = 0.01), respectively. However, in the multivariable analysis this survival benefit did not remain (PFS HR = 1.03, 95% CI 0.91-1.15; OS HR=0.92, 95%CI 0.81-1.04). The OS of the 141 patients who had an UAP and achieved CR compared to the 341 patients who had an UAP with MR was 54.6 compared to 40.4 mos (p=0.0005).
UAP procedures should only be performed when CR is attainable. A significant proportion of patients with MR were left with diaphragmatic disease that could potentially be completely resected.
研究在一组最佳减瘤的晚期上皮性卵巢癌（EOC）或原发性腹膜癌（PPC）患者中进行上腹部手术（UAP）的效用，并确定积极手术可能影响生存的潜在领域。
我们回顾了妇科肿瘤学组（GOG）182 号试验中纳入的 2655 名患者，这些患者均接受了完全切除（CR）或微小残留（MR）疾病<1cm 的治疗。收集了人口统计学、病理学、手术和结局数据。UAP 包括膈肌剥离或切除术、肝切除术、脾切除术、胰腺切除术和肝门手术。通过 Kaplan-Meier 和比例风险方法评估 UAP 和 CR 对 PFS/OS 的影响。
482 名患者（18.1%）共进行了 590 次 UAP。其中 351 例（13.1%）行膈肌手术，112 例（4.2%）行肝手术，108 例（4%）行脾切除术，12 例（0.5%）行胰腺切除术，7 例（0.2%）行肝门手术。与未行 UAP 的患者相比，行 UAP 的患者的 PFS 为 18.2 个月（mos）和 14.8 mos（p<0.01），OS 为 49.8 mos 和 43.7 mos（p=0.01）。然而，在多变量分析中，这种生存获益并未持续存在（PFS HR=1.03，95%CI 0.91-1.15；OS HR=0.92，95%CI 0.81-1.04）。在 141 名 UAP 并达到 CR 的患者与 341 名 UAP 且 MR 的患者相比，OS 为 54.6 个月与 40.4 mos（p=0.0005）。
只有在能够达到 CR 的情况下才应进行 UAP 手术。很大一部分 MR 患者的膈肌疾病仍有潜在的完全切除机会。
