Colombo P E, Labaki M, Fabbro M, Bertrand M, Mourregot A, Gutowski M, Saint-Aubert B, Quenet F, Rouanet P, Mollevi C
Department of Surgical Oncology, Montpellier Cancer Institute (ICM), 34298 Montpellier, France.
Department of Surgical Oncology, Montpellier Cancer Institute (ICM), 34298 Montpellier, France.
Gynecol Oncol. 2014 Nov;135(2):223-30. doi: 10.1016/j.ygyno.2014.09.002. Epub 2014 Sep 16.
Complete surgery with no macroscopic residual disease (RD) at primary (PDS) or interval debulking surgery (IDS) is the main objective of surgery in advanced epithelial ovarian cancer (EOC). The aim of this work was to evaluate the impact on survival of the number of neoadjuvant chemotherapy (NAC) cycles before IDS in EOC patients.
Data from EOC patients (stages IIIC-IV), operated on between 1995 and 2010 were consecutively recorded. NAC/IDS patients were analyzed according to the number of preoperative cycles (<4=group B1; >4=group B2) and compared with patients receiving PDS (group A). Patients with complete resection were specifically analyzed.
367 patients were analyzed, 220 received PDS and 147 had IDS/NAC. In group B, 37 patients received more than 4 NAC cycles (group B2). Group B2 patients presented more frequently stage IV disease at diagnosis (p<0.01) compared to groups A and B1. The rate of complete cytoreduction was higher in group B (p<0.001). Patients with no RD after IDS and who had received more than 4 NAC cycles had poor survival (p<0.001) despite complete removal of their tumor (relative risk of death after multivariate analysis of 3 (p<0.001)) with an independent impact from disease stage and WHO performance status.
Patients with advanced EOC receiving complete IDS after more than 4cycles of NAC have poor prognosis. Despite worse prognostic factors observed in this group of patients, our study reinforces the concept of early and complete removal of all macroscopic tumors in the therapeutic sequence of EOC.
在晚期上皮性卵巢癌（EOC）中，初次肿瘤细胞减灭术（PDS）或中间性肿瘤细胞减灭术（IDS）时实现无肉眼可见残留病灶（RD）的完全手术切除是手术的主要目标。本研究旨在评估EOC患者在IDS前接受新辅助化疗（NAC）的周期数对生存的影响。
连续记录1995年至2010年间接受手术的EOC患者（IIIC-IV期）的数据。根据术前化疗周期数（<4个周期=B1组；>4个周期=B2组）对NAC/IDS患者进行分析，并与接受PDS的患者（A组）进行比较。对实现完全切除的患者进行了专门分析。
共分析了367例患者，220例接受了PDS，147例接受了IDS/NAC。在B组中，37例患者接受了超过4个周期的NAC（B2组）。与A组和B1组相比，B2组患者在诊断时IV期疾病更为常见（p<0.01）。B组的完全肿瘤细胞减灭率更高（p<0.001）。IDS后无RD且接受了超过4个周期NAC的患者，尽管肿瘤已完全切除，但生存情况较差（p<0.001），多因素分析后的死亡相对风险为3（p<0.001），且受疾病分期和世界卫生组织体能状态的独立影响。
接受超过4个周期NAC后行完全IDS的晚期EOC患者预后较差。尽管该组患者存在更差的预后因素，但我们的研究强化了在EOC治疗过程中早期并完全切除所有肉眼可见肿瘤的理念。
