McNally Leah, Teng Nelson N H, Kapp Daniel S, Karam Amer
Departments of *Gynecologic Oncology and †Radiation Oncology, Stanford Medical Center, Stanford, CA.
Int J Gynecol Cancer. 2015 May;25(4):607-15. doi: 10.1097/IGC.0000000000000412.
Although omentectomy is part of the staging and treatment of epithelial ovarian cancer (EOC), its performance in a patient with a grossly normal omentum—acknowledging its role in debulking gross tumor deposits—has never been definitively shown to improve survival.
METHODS/MATERIALS: Using Surveillance, Epidemiology, and End Results data from 1998 to 2010, we identified patients with EOC and assessed their age, race, year of diagnosis, tumor grade, histologic subtype, International Federation of Gynecology and Obstetrics stage, lymph node dissection, nodal findings, and performance of omentectomy. We compared disease-specific survival (DSS) based on the presence or absence of omentectomy using log-rank univariate analysis, Cox multivariate analysis, and Kaplan-Meier survival curves.
A total of 20,975 patients with invasive EOC underwent surgical treatment. Initial univariate analysis indicated a lower mean DSS with performance of omentectomy. However, multivariate analysis demonstrated no significant association between DSS and performance of omentectomy (hazard ratio, 0.978; P = 0.506). The DSS was improved if lymphadenectomy was performed (hazard ratio, 0.60; P < 0.001). In recent years, there was a trend toward decreased performance of omentectomy.To look specifically at patients without bulky omental disease, a subset analysis was done looking at patients with stage I-IIIA disease who had had lymphadenectomy performed. There were 5454 patients in the group who underwent an omentectomy and 2404 patients in the group who did not. No difference in DSS was seen between the groups based on performance of omentectomy (P = 0.89). However, the analysis was limited by the lack of Surveillance, Epidemiology, and End Results data on the extent of omentectomy, amount of residual disease, and adjuvant chemotherapy.
In this analysis, performance of omentectomy in patients with EOC without bulky disease (≤stage IIIA) did not seem to confer improvement in survival. A randomized control trial would be needed to fully address this question.
虽然网膜切除术是上皮性卵巢癌（EOC）分期和治疗的一部分，但其在大网膜大体正常的患者中的应用——尽管其在切除肉眼可见的肿瘤沉积物方面发挥作用——从未被明确证明能提高生存率。
方法/材料：利用1998年至2010年的监测、流行病学和最终结果数据，我们确定了EOC患者，并评估了他们的年龄、种族、诊断年份、肿瘤分级、组织学亚型、国际妇产科联盟分期、淋巴结清扫情况、淋巴结检查结果以及网膜切除术的实施情况。我们使用对数秩单变量分析、Cox多变量分析和Kaplan-Meier生存曲线，比较了基于是否进行网膜切除术的疾病特异性生存率（DSS）。
共有20975例侵袭性EOC患者接受了手术治疗。最初的单变量分析表明，进行网膜切除术的患者平均DSS较低。然而，多变量分析显示DSS与网膜切除术的实施之间无显著关联（风险比，0.978；P = 0.506）。如果进行淋巴结清扫，DSS会得到改善（风险比，0.60；P < 0.001）。近年来，网膜切除术的实施有减少的趋势。为了专门研究没有大量网膜疾病的患者，对进行了淋巴结清扫的I-IIIA期疾病患者进行了亚组分析。该组中有5454例患者接受了网膜切除术，2404例患者未接受。基于网膜切除术的实施情况，两组之间的DSS没有差异（P = 0.89）。然而，该分析受到缺乏关于网膜切除术范围、残留疾病量和辅助化疗的监测、流行病学和最终结果数据的限制。
在本分析中，对于无大量疾病（≤IIIA期）的EOC患者，实施网膜切除术似乎并未提高生存率。需要进行一项随机对照试验来全面解决这个问题。
