Rajanbabu Anupama, Kuriakose Santhosh, Ahmad Sheikh Zahoor, Khadakban Tejal, Khadakban Dhiraj, Venkatesan R, Vijaykumar D K
Department of Surgical and Gynaecologic Oncology, Amrita Institute of Medical Sciences and Amrita Vishwavidyapeetham, Kochi, Kerala, India.
Ecancermedicalscience. 2014 Apr 17;8:422. doi: 10.3332/ecancer.2014.422. eCollection 2014.
To audit our performance as a dedicated gynaecologic oncology unit and to analyse how it has evolved over the years.To retrospectively evaluate the outcome of advanced ovarian cancer treated with neoadjuvant chemotherapy (NACT) followed by interval surgery versus upfront surgery.
One hundred and ninety-eight patients with advanced epithelial ovarian cancer (EOC) who were treated from 2004 to 2010 were analysed. Eighty-two patients (41.4%) underwent primary surgery and 116 (58.6%) received NACT. Overall, an optimal debulking rate of 81% was achieved with 70% for primary surgery and 88% following NACT. The optimal cytoreduction rate has improved from 55% in 2004 to 97% in 2010. In primary surgery, the optimal debulking rate increased from 42.8% in 2004 to 93% in 2010, whereas in NACT group the optimal cytoreduction rate increased from 60% to 100% by 2010. On the basis of the surgical complexity scoring system it was found that surgeries with intermediate complexity score had progressively increased over the years. There was a mean follow-up of 21 months ranging from 6 to 70 months. The progression-free survival and overall survival (OS) in patients undergoing primary surgery were 23 and 40 months, respectively, while it was 22 and 40 months in patients who received NACT. However, patients who had suboptimal debulking, irrespective of primary treatment, had significantly worse OS (26 versus 47 months) compared with those who had optimal debulking.
As a dedicated gynaecologic oncology unit there has been an increase in the optimal cytoreduction rates. The number of complex surgeries, as denoted by the category of intermediate complexity score, has increased. Patients with advanced EOC treated with NACT followed by interval debulking have comparable survival to the patients undergoing primary surgery. Optimal cytoreduction irrespective of primary modality of treatment gives better survival.
评估我们作为一个专业妇科肿瘤科室的表现，并分析其多年来的发展情况。回顾性评估晚期卵巢癌采用新辅助化疗（NACT）后行间隔期手术与直接手术的治疗结果。
分析了2004年至2010年期间接受治疗的198例晚期上皮性卵巢癌（EOC）患者。82例（41.4%）患者接受了初次手术，116例（58.6%）接受了NACT。总体而言，最佳肿瘤细胞减灭率达到81%，初次手术时为70%，NACT后为88%。最佳细胞减灭率已从2004年的55%提高到2010年的97%。在初次手术中，最佳肿瘤细胞减灭率从2004年的42.8%提高到2010年的93%，而在NACT组中，到2010年最佳细胞减灭率从60%提高到100%。根据手术复杂程度评分系统发现，中等复杂程度评分的手术多年来逐渐增加。平均随访时间为21个月，范围为6至70个月。接受初次手术患者的无进展生存期和总生存期（OS）分别为23个月和40个月，而接受NACT的患者分别为22个月和40个月。然而，无论初始治疗如何，肿瘤细胞减灭不彻底的患者与肿瘤细胞减灭彻底的患者相比，OS明显更差（26个月对47个月）。
作为一个专业妇科肿瘤科室，最佳细胞减灭率有所提高。中等复杂程度评分类别的复杂手术数量有所增加。接受NACT后行间隔期肿瘤细胞减灭术的晚期EOC患者与接受初次手术的患者生存期相当。无论初始治疗方式如何，最佳细胞减灭术可带来更好的生存。
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