Petrillo Marco, Zannoni Gian Franco, Tortorella Lucia, Pedone Anchora Luigi, Salutari Vanda, Ercoli Alfredo, Margariti Pasquale Alessandro, Scambia Giovanni, Fagotti Anna
Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy.
Department of Human Pathology, Catholic University of the Sacred Heart, Rome, Italy.
Am J Obstet Gynecol. 2014 Dec;211(6):632.e1-8. doi: 10.1016/j.ajog.2014.06.034. Epub 2014 Jun 19.
The objective of the study was to analyze in a large series of unresectable advanced ovarian cancer (AOC) patients the prognostic role of pathological response to neoadjuvant chemotherapy (NACT).
We retrospectively evaluated 322 unresectable AOC patients treated with NACT followed by interval debulking surgery (IDS). Pathological response was classified as follows: complete (cPR) in the absence of residual disease, microscopic (microPR) in the presence of microscopic tumor foci (maximum diameter ≤3 mm), and macroscopic (macroPR) when macroscopic residual disease was detected.
cPR was observed in 21 (6.5%), microPR in 104 (32.3%), and macroPR in 197 (61.2%) patients. No differences were observed in the distribution of baseline clinicopathological characteristics between the groups. Median progression-free survival was 36 months in cPR, 16 in microPR, and 13 in macroPR (P = .001). Median overall survival was 72 months in cPR, 38 in microPR, and 29 in macroPR (P = .018). The survival differences between microPR and macroPR patients were not confirmed when the analysis included only cases resected to no gross residual disease at IDS. cPR retained the independent prognostic role in the multivariate analysis. International Federation of Gynecology and Obstetrics stage IV was the only negative independent predictor of cPR (χ(2) = 5.362, P = .021).
cPR is an uncommon event in AOC patients receiving NACT and is associated with a longer progression-free survival and overall survival compared with women showing no cPR, even in patients receiving IDS with no gross residual disease. The proposed classification of pathological response may serve in the next future as an easily assessable and highly valuable prognostic tool in this clinical setting.
本研究旨在分析大量不可切除的晚期卵巢癌（AOC）患者中，新辅助化疗（NACT）的病理反应的预后作用。
我们回顾性评估了322例接受NACT后行间歇性肿瘤细胞减灭术（IDS）的不可切除AOC患者。病理反应分类如下：无残留病灶为完全缓解（cPR），存在微小肿瘤病灶（最大直径≤3 mm）为微小缓解（microPR），检测到肉眼残留病灶为肉眼缓解（macroPR）。
21例（6.5%）患者达到cPR，104例（32.3%）为microPR，197例（61.2%）为macroPR。各组间基线临床病理特征分布无差异。cPR患者的无进展生存期（PFS）中位数为36个月，microPR为16个月，macroPR为13个月（P = .001）。总生存期（OS）中位数在cPR患者中为72个月，microPR为38个月，macroPR为29个月（P = .018）。当分析仅包括IDS时切除至无肉眼残留病灶的病例时，microPR和macroPR患者之间的生存差异未得到证实。cPR在多变量分析中保留独立预后作用。国际妇产科联盟（FIGO）IV期是cPR唯一的阴性独立预测因素（χ(2)=5.362，P = .021）。
在接受NACT的AOC患者中，cPR是一种不常见的情况，与无cPR的女性相比，其无进展生存期和总生存期更长，即使在接受IDS且无肉眼残留病灶的患者中也是如此。所提出的病理反应分类在未来可能成为这种临床情况下一种易于评估且极具价值的预后工具。
