Department of Gynecology and Obstetrics, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria.
Gynecol Oncol. 2013 Oct;131(1):15-20. doi: 10.1016/j.ygyno.2013.07.086. Epub 2013 Jul 20.
Cytoreductive surgery and platinum-based systemic therapy constitute the standard treatment of patients with advanced ovarian cancer. The aim of the present study was to evaluate whether the time interval from surgery to start of chemotherapy has an impact on clinical outcome.
Data of 191 patients with advanced serous (FIGO III-IV) ovarian cancer from the prospective multicenter study OVCAD (OVarian CAncer Diagnosis) were analyzed. All patients underwent primary surgery followed by platinum-based chemotherapy.
The 25%, 50%, and 75% quartiles of intervals from surgery to start of chemotherapy were 22, 28, and 38 days, respectively (range, 4-158 days). Preoperative performance status (P<0.001), extent of surgery (P<0.001), and perioperative complications (P<0.001) correlated with intervals from surgery to initiation of chemotherapy. Timing of cytotoxic treatment [≤ 28 days versus >28 days; hazard ratio (HR) 1.73 (95% confidence interval 1.08-2.78), P=0.022], residual disease [HR 2.95 (95% confidence interval 1.87-4.67), P<0.001], and FIGO stage [HR 2.26 (95% confidence interval 1.41-3.64), P=0.001] were significant prognostic factors for overall survival in multivariate analysis. While the interval from surgery to start of chemotherapy did not possess prognostic significance in patients without postoperative residual disease (n=121), it significantly correlated with overall survival in patients with postoperative residual disease [n=70, HR 2.24 (95% confidence interval 1.08-4.66), P=0.031].
Our findings suggest that delayed initiation of chemotherapy might compromise overall survival in patients with advanced serous ovarian cancer, especially when suboptimally debulked.
细胞减灭术和基于铂类的系统治疗构成了晚期卵巢癌患者的标准治疗方法。本研究旨在评估手术至化疗开始的时间间隔是否会对临床结果产生影响。
对前瞻性多中心 OVCAD（卵巢癌诊断）研究中的 191 例晚期浆液性（FIGO III-IV）卵巢癌患者的数据进行了分析。所有患者均接受了初始手术，随后进行了基于铂类的化疗。
手术至化疗开始的时间间隔的 25%、50%和 75%四分位数分别为 22、28 和 38 天（范围为 4-158 天）。术前体能状态（P<0.001）、手术范围（P<0.001）和围手术期并发症（P<0.001）与手术至化疗开始的时间间隔相关。细胞毒性治疗的时机[≤28 天与>28 天；风险比（HR）1.73（95%置信区间 1.08-2.78），P=0.022]、残留疾病[HR 2.95（95%置信区间 1.87-4.67），P<0.001]和 FIGO 分期[HR 2.26（95%置信区间 1.41-3.64），P=0.001]是多因素分析中总体生存的显著预后因素。虽然在无术后残留疾病的患者（n=121）中，手术至化疗开始的时间间隔没有预后意义，但在有术后残留疾病的患者（n=70）中，与总体生存显著相关[HR 2.24（95%置信区间 1.08-4.66），P=0.031]。
我们的研究结果表明，延迟启动化疗可能会影响晚期浆液性卵巢癌患者的总体生存，尤其是在未充分减瘤的情况下。
