Neil S. Horowitz, Brigham and Women's Hospital, Boston, MA; Austin Miller, Roswell Park Cancer Institute, Buffalo, NY; Bunja Rungruang, Georgia Regents University, Augusta, GA; Scott D. Richard, Hahnemann University Hospital, Philadelphia; Thomas C. Krivak, Western Pennsylvania Hospital, Pittsburgh, PA; Noah Rodriguez, Kaiser Permanente Irvine Medical Center, Irvine, CA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Chad A. Hamilton, Walter Reed National Military Medical Center, Bethesda, MD; and G. Larry Maxwell, Inova Fairfax Women's Hospital, Falls Church, VA.
J Clin Oncol. 2015 Mar 10;33(8):937-43. doi: 10.1200/JCO.2014.56.3106. Epub 2015 Feb 9.
To examine the effects of disease burden, complex surgery, and residual disease (RD) status on progression-free (PFS) and overall survival (OS) in patients with advanced epithelial ovarian cancer (EOC) or primary peritoneal cancer (PPC) and complete surgical resection (R0) or < 1 cm of RD (MR) after surgical cytoreduction.
Demographic, pathologic, surgical, and outcome data were collected from 2,655 patients with EOC or PPC enrolled onto the Gynecologic Oncology Group 182 study. The effects of disease distribution (disease score [DS]) and complexity of surgery (complexity score [CS]) on PFS and OS were assessed using the Kaplan-Meier method and multivariable regression analysis.
Consistent with existing literature, patients with MR had worse prognosis than R0 patients (PFS, 15 v 29 months; P < .01; OS, 41 v 77 months; P < .01). Patients with the highest preoperative disease burden (DS high) had shorter PFS (15 v 23 or 34 months; P < .01) and OS (40 v 71 or 86 months; P < .01) compared with those with DS moderate or low, respectively. This relationship was maintained in the subset of R0 patients with PFS (18.3 v 33.2 months; DS moderate or low: P < .001) and OS (50.1 v 82.8 months; DS moderate or low: P < .001). After controlling for DS, RD, an interaction term for DS/CS, performance status, age, and cell type, CS was not an independent predictor of either PFS or OS.
In this large multi-institutional sample, initial disease burden remained a significant prognostic indicator despite R0. Complex surgery does not seem to affect survival when accounting for other confounding influences, particularly RD.
研究疾病负担、复杂手术和残留疾病（RD）状态对完全手术减瘤（R0）或 RD ＜ 1cm（MR）后高级上皮性卵巢癌（EOC）或原发性腹膜癌（PPC）患者无进展生存（PFS）和总生存（OS）的影响。
从妇科肿瘤学组 182 研究入组的 2655 例 EOC 或 PPC 患者中收集人口统计学、病理、手术和结局数据。采用 Kaplan-Meier 法和多变量回归分析评估疾病分布（疾病评分[DS]）和手术复杂性（复杂性评分[CS]）对 PFS 和 OS 的影响。
与现有文献一致，MR 患者的预后较 R0 患者差（PFS，15 比 29 个月；P＜0.01；OS，41 比 77 个月；P＜0.01）。术前疾病负担最高（DS 高）的患者 PFS（15 比 23 或 34 个月；P＜0.01）和 OS（40 比 71 或 86 个月；P＜0.01）均较 DS 中或低者短。在 R0 患者亚组中，这种关系仍然存在，PFS（18.3 比 33.2 个月；DS 中或低：P＜0.001）和 OS（50.1 比 82.8 个月；DS 中或低：P＜0.001）。在控制 DS、RD、DS/CS 交互项、体能状态、年龄和细胞类型后，CS 不是 PFS 或 OS 的独立预测因素。
在这项大型多机构样本中，尽管达到了 R0，但初始疾病负担仍然是一个重要的预后指标。在考虑其他混杂因素，尤其是 RD 时，复杂手术似乎不会影响生存。
