卵巢交界性肿瘤手术分期的新指南

New Pointers for Surgical Staging of Borderline Ovarian Tumors.

作者信息

Bendifallah Sofiane, Nikpayam Myriam, Ballester Marcos, Uzan Catherine, Fauvet Raffaele, Morice Philippe, Darai Emile

机构信息

Department of Obstetrics and Gynaecology, University Hospital of Tenon, Paris, France.

Assistance Publique des Hôpitaux de Paris, Université Pierre et Marie Curie, Paris 6, France.

出版信息

Ann Surg Oncol. 2016 Feb;23(2):443-9. doi: 10.1245/s10434-015-4784-9. Epub 2015 Aug 5.

DOI:10.1245/s10434-015-4784-9

PMID:26442919

Abstract

BACKGROUND

Surgical management of borderline ovarian tumors (BOTs) is similar to that of ovarian cancer apart from lymphadenectomy. However, the complete procedure including peritoneal washing, infracolic omentectomy and random peritoneal biopsies remains a subject of controversy especially in presumed early stage BOTs. To evaluate the prognostic value of complete surgical staging on recurrence rates, recurrence free (RFS) and overall survival (OS) in a multicentre cohort of BOTs.

METHODS

This retrospective multicentre study included 428 patients with BOTs diagnosed from January 1980 to December 2008. Survival estimates were based on Kaplan-Meier calculations and RFS defined as the time from the date of surgery to the date of recurrence.

RESULTS

The median time of follow-up was 94.9 months (range: 60.00-207.3). The overall recurrence rate was 23.8 %. There was no difference in 5-year RFS between patients with and without complete surgical staging 78.1 % (95 % CI 68.9-88.6) and 70.9 % (95 % CI 64.6-77.8), (p = 0.0806). In the whole cohort, 5-year OS was higher for patients with complete surgical staging 98.4 % (95 % CI 96.8-1.0) and 93.8 % (95 % CI 88.1-1), (p = 0.0182) but this difference was not significant for patients with FIGO stage I 98.6 % (95 % CI 96.7-1) and 92.7 % (95 % CI 83.4-1.0), p = 0.1275, respectively.

CONCLUSIONS

Complete staging surgery should be considered as a cornerstone treatment for patients with advanced stage BOT but not for those with stage I disease.

摘要

背景

除淋巴结清扫外，卵巢交界性肿瘤（BOT）的手术管理与卵巢癌相似。然而，包括腹腔冲洗、结肠下网膜切除术和随机腹膜活检在内的完整手术程序仍是一个有争议的话题，特别是在假定的早期BOT中。为了评估完整手术分期对多中心队列BOT患者复发率、无复发生存期（RFS）和总生存期（OS）的预后价值。

方法

这项回顾性多中心研究纳入了1980年1月至2008年12月期间诊断为BOT的428例患者。生存估计基于Kaplan-Meier计算，RFS定义为从手术日期到复发日期的时间。

结果

中位随访时间为94.9个月（范围：60.00 - 207.3）。总复发率为23.8%。接受和未接受完整手术分期的患者5年RFS无差异，分别为78.1%（95%CI 68.9 - 88.6）和70.9%（95%CI 64.6 - 77.8），（p = 0.0806）。在整个队列中，接受完整手术分期的患者5年OS更高，分别为98.4%（95%CI 96.8 - 1.0）和93.8%（95%CI 88.1 - 1），（p = 0.0182），但对于国际妇产科联盟（FIGO）I期患者，差异不显著，分别为98.6%（95%CI 96.7 - 1）和92.7%（95%CI 83.4 - 1.0），p = 0.1275。