Seifert Heike, Georgiou Alexandros, Alexander Helen, McLachlan Jennifer, Bodla Shankar, Kaye Stan, Barton Desmond, Nobbenhuis Marielle, Gore Martin, Banerjee Susana
Gynaecology Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, United Kingdom.
Department of Statistics, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom.
Gynecol Oncol. 2015 Nov;139(2):216-20. doi: 10.1016/j.ygyno.2015.08.015. Epub 2015 Aug 28.
Some guidelines suggest that poor performance status (PS) is a contraindication to 1st line chemotherapy. Poor PS is a known adverse prognostic factor in advanced epithelial ovarian cancer (EOC). We show in this retrospective analysis that 1st line chemotherapy in this patient group is not only safe but is associated with good outcomes.
A retrospective review of 114 patients with stage III/IV EOC, who presented with a PS ≥3 at diagnosis and treated as inpatients with upfront platinum-based chemotherapy between 2000 and 2013, at the Royal Marsden Hospital, was conducted. The association between clinical parameters and the likelihood of completion of chemotherapy and overall survival (OS) was assessed.
66% of patients completed ≥6cycles of platinum-based chemotherapy. Prognostic factors for completion of chemotherapy were improvement of PS during hospital stay (p<0.001) and doublet-chemotherapy with carboplatin/paclitaxel compared to single-agent carboplatin (p=0.004). A negative trend for completion of treatment was seen for patients with low albumin (<25g/l) and low CA125 levels at baseline. The median OS for all patients was 13.1months (95% CI: 10.4-15.8) and 21.2months (95% CI: 16.5-25.8) for those who completed 6cycles of chemotherapy.
Upfront platinum-based chemotherapy is feasible, beneficial and tolerable for the majority of patients with advanced EOC and poor PS. Guidelines suggesting that best supportive care is the preferred option for poor PS patients with solid tumours should be revised to exclude those with advanced EOC. An aggressive approach utilising neoadjuvant carboplatin plus paclitaxel should be regarded as standard of care.
一些指南表明，较差的体能状态（PS）是一线化疗的禁忌证。较差的PS是晚期上皮性卵巢癌（EOC）已知的不良预后因素。我们在这项回顾性分析中表明，该患者群体的一线化疗不仅安全，而且与良好的预后相关。
对2000年至2013年间在皇家马斯登医院诊断时PS≥3并接受一线铂类化疗住院治疗的114例III/IV期EOC患者进行了回顾性研究。评估了临床参数与化疗完成可能性及总生存期（OS）之间的关联。
66%的患者完成了≥6周期的铂类化疗。化疗完成的预后因素包括住院期间PS改善（p<0.001）以及与单药卡铂相比，采用卡铂/紫杉醇联合化疗（p=0.004）。基线白蛋白水平低（<25g/l）和CA125水平低的患者治疗完成呈负向趋势。所有患者的中位OS为13.1个月（95%CI：10.4 - 15.8），完成6周期化疗的患者为21.2个月（95%CI：16.5 - 25.8）。
对于大多数晚期EOC且PS较差的患者，一线铂类化疗是可行、有益且可耐受的。建议对PS较差的实体瘤患者采用最佳支持治疗作为首选方案的指南应进行修订，以排除晚期EOC患者。采用新辅助卡铂加紫杉醇的积极治疗方法应被视为标准治疗方案。
