肿瘤减灭术和腹腔内化疗与接受新辅助化疗的卵巢癌患者的发病率降低相关。
Debulking surgery and intraperitoneal chemotherapy are associated with decreased morbidity in women receiving neoadjuvant chemotherapy for ovarian cancer.
机构信息
Tulane Cancer Center, Tulane University School of Medicine, New Orleans, LA.
出版信息
Int J Gynecol Cancer. 2014 Jan;24(1):43-7. doi: 10.1097/IGC.0000000000000009.
OBJECTIVE
The aims of this study were to compare the rate of completion of optimal debulking and/or 6 cycles of intraperitoneal (IP) chemotherapy in women with International Federation of Gynecologists and Obstetricians stage III/IV ovarian cancer undergoing neoadjuvant chemotherapy (NACT) versus primary surgery (PS) and to compare morbidity between these 2 groups.
METHODS
Ninety-six subjects with stage III/IV ovarian cancer who underwent either NACT or PS were identified. Data comparisons include rate of optimal debulking and completion rate of 6 cycles of IP chemotherapy. Other data collected included surgical times, length of stay, intensive care unit admissions, blood transfusions, bowel resections, major complications, and dose reductions. SigmaStat version 2.0 was used for statistical analysis.
RESULTS
Of the 96 subjects, 38 received NACT and 58 had PS. All 14 subjects with stage IV disease received NACT, and all experienced resolution of pleural effusion, based on computed tomographic imaging. Thirty-five (92%) of 38 NACT subjects versus 47 (81%) of 58 PS subjects were optimally debulked (P = 0.08). Thirty-six (95%) of 38 NACT subjects versus 37 (64%) of 58 PS subjects completed IP chemotherapy (P < 0.001). Length of stay was 3.26 (NACT) versus 5.08 (PS) days (P < 0.001). Intensive care unit admissions were 1 of 38 (NACT) versus 12 of 58 (PS) (P < 0.001). Bowel resections were done in 2 of 38 (NACT) versus 14 of 38 (PS) (P < 0.05). Duration of surgery was 96 minutes (NACT) versus 138 minutes (PS) (P < 0.001). A trend to fewer dose reductions occurred in NACT (1/38) versus PS (8/58) (P = 0.056).
CONCLUSIONS
The NACT subjects were more likely to complete IP chemotherapy and had decreased length of stay, intensive care unit admissions, bowel resections, and duration of surgery. Both optimal debulking and dose reductions were numerically but not statistically associated with NACT versus PS. This likely reflects a relatively high overall rate of optimal debulking and low rate of dose reductions in these subjects and would require a larger group to determine significance.
目的
本研究旨在比较新辅助化疗（NACT）与直接手术（PS）治疗国际妇产科联盟（FIGO）分期 III/IV 卵巢癌患者的完全肿瘤细胞减灭术（optimal debulking）和/或 6 个周期腹腔内（IP）化疗的完成率，并比较两组之间的发病率。
方法
共纳入 96 例接受 NACT 或 PS 的 III/IV 期卵巢癌患者。数据比较包括完全肿瘤细胞减灭术的完成率和 6 个周期 IP 化疗的完成率。收集的其他数据包括手术时间、住院时间、重症监护病房入院、输血、肠切除术、主要并发症和剂量减少。使用 SigmaStat 版本 2.0 进行统计分析。
结果
在 96 例患者中，38 例接受 NACT，58 例接受 PS。所有 14 例 IV 期疾病患者均接受 NACT，根据计算机断层扫描成像，所有患者的胸腔积液均得到缓解。38 例 NACT 患者中有 35 例（92%）达到完全肿瘤细胞减灭术，58 例 PS 患者中有 47 例（81%）达到完全肿瘤细胞减灭术（P=0.08）。38 例 NACT 患者中有 36 例（95%）完成 6 个周期 IP 化疗，58 例 PS 患者中有 37 例（64%）完成 6 个周期 IP 化疗（P<0.001）。NACT 组的住院时间为 3.26 天，PS 组为 5.08 天（P<0.001）。NACT 组有 1 例（1/38）重症监护病房入院，PS 组有 12 例（12/58）（P<0.001）。NACT 组有 2 例（2/38）行肠切除术，PS 组有 14 例（14/38）（P<0.05）。NACT 组的手术时间为 96 分钟，PS 组为 138 分钟（P<0.001）。NACT 组剂量减少的发生率（1/38）低于 PS 组（8/58），但无统计学意义（P=0.056）。
结论
NACT 组更有可能完成 IP 化疗，且住院时间、重症监护病房入院、肠切除术和手术时间均较短。完全肿瘤细胞减灭术和剂量减少与 NACT 与 PS 之间均存在关联，但无统计学意义。这可能反映了这些患者中完全肿瘤细胞减灭术的总体完成率较高，剂量减少率较低，需要更大的样本量才能确定其统计学意义。
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