Petrillo M, Pedone Anchora L, Tortorella L, Fanfani F, Gallotta V, Pacciani M, Scambia G, Fagotti A
Department of Obstetrics and Gynaecology, Catholic University of the Sacred Heart, Rome, Italy.
Division of Minimally Invasive Gynaecological Surgery, St. Maria Hospital, University of Perugia, Terni, Italy.
Gynecol Oncol. 2014 Aug;134(2):257-61. doi: 10.1016/j.ygyno.2014.05.029. Epub 2014 Jun 5.
To analyze the impact of secondary cytoreductive surgery (SCS) on survival outcome in a retrospective series of isolated platinum-resistant recurrent ovarian cancer.
We evaluate a consecutive series of 268 ovarian cancer patients with platinum-resistant relapse. Isolated recurrence was defined as the presence of a single nodule, in a single anatomic site, and was observed in 27 cases (10.1%). In all women the presence of isolated relapse was assessed at radiological evaluation, and surgically confirmed in the SCS group.
Among the 27 patients with isolated recurrence, 16 (59.3%) received chemotherapy alone, and 11 (40.7%) complete SCS followed by non-platinum based chemotherapy. No significant differences were observed in the distribution of baseline clinico-pathological characteristics, pattern of recurrent disease, duration of PFI, and type of salvage chemotherapy between the two groups. In the SCS group, 6 patients (54.5%) showed isolated peritoneal relapse and 5 women (45.4%) showed isolated lymph nodal recurrence, and were treated with peritonectomy and lymphadenectomy, according with site of relapse. Two post-operative complications (18.2%) occurred: asymptomatic lymphocele and groin wound dehiscence. SCS significantly prolonged median time to first progression (12 months vs 3 months; p-value=0.016), median time to second progression (8 months vs 3 months; p-value=0.037), and post-relapse survival (PRS) (32 months vs 8 months; p-value=0.002). Residual tumor at 1st surgery (X(2)=5.690; p-value=0.017), duration of PFI (X(2)=5.401; p-value=0.020), and complete SCS (X(2)=4.250; p-value=0.039) retains independent prognostic role for PRS in multivariate analysis.
SCS prolongs PRS compared to chemotherapy alone in isolated platinum-resistant recurrent ovarian cancer.
在一项回顾性研究系列中，分析二次细胞减灭术（SCS）对孤立性铂耐药复发性卵巢癌生存结局的影响。
我们评估了连续的268例铂耐药复发的卵巢癌患者。孤立性复发定义为在单一解剖部位存在单个结节，27例（10.1%）患者出现这种情况。在所有女性中，通过影像学评估判断是否存在孤立性复发，并在SCS组通过手术进行确认。
在27例孤立性复发患者中，16例（59.3%）仅接受化疗，11例（40.7%）接受了完整的SCS，随后进行非铂类化疗。两组在基线临床病理特征分布、复发性疾病模式、无进展生存期（PFI）持续时间和挽救性化疗类型方面未观察到显著差异。在SCS组中，6例患者（54.5%）表现为孤立性腹膜复发，5例女性（45.4%）表现为孤立性淋巴结复发，并根据复发部位接受了腹膜切除术和淋巴结切除术。发生了2例术后并发症（18.2%）：无症状性淋巴囊肿和腹股沟伤口裂开。SCS显著延长了至首次进展的中位时间（12个月对3个月；p值 = 0.016）、至第二次进展的中位时间（8个月对3个月；p值 = 0.037）以及复发后生存期（PRS）（32个月对8个月；p值 = 0.002）。在多因素分析中，首次手术时的残留肿瘤（X(2)=5.690；p值 = 0.017）、PFI持续时间（X(2)=5.401；p值 = 0.020）和完整的SCS（X(2)=4.250；p值 = 0.039）对PRS具有独立的预后作用。
在孤立性铂耐药复发性卵巢癌中，与单纯化疗相比，SCS可延长PRS。
