da Costa Alexandre Andre Balieiro Anastacio, Valadares Camila V, Mantoan Henrique, Saito Augusto, Salvadori Marcella Marinelli, Guimarães Andreia Paiva, Sanches Solange Moraes, Achatz Maria Isabel Alves de Souza Wadington, Baiocchi Glauco
*Medical Oncology Department, †Gynecology Oncology Department, and ‡Oncogenetics Department, AC Camargo Cancer Center, Sao Paulo, SP, Brazil.
Int J Gynecol Cancer. 2016 Mar;26(3):449-55. doi: 10.1097/IGC.0000000000000649.
Secondary cytoreductive surgery (SCS) is an option for treating patients with recurrent ovarian cancer. Three ongoing randomized trials are comparing SCS plus chemotherapy with chemotherapy alone, and few comparative studies have been published.
We performed a retrospective review of data on 209 patients with recurrent ovarian carcinoma who were treated at a single institution from 2000 to 2013. We analyzed prognostic factors in the recurrence setting to determine the value of SCS in a multivariate model, including propensity score, by prognostic group.
In the univariate analysis, younger than 65 years, personal or family history of breast or ovarian cancer, stage I-II at diagnosis, residual disease 10 mm or less after primary debulking surgery, performance status 1 or less, CA125 less than 100, only 1 metastatic site of recurrence, platinum-free interval of more than 12 months, and SCS correlated with better overall survival. In the multivariate model, including propensity score, SCS remained associated with a 66% decrease in the risk of death (hazard ratio, 0.34; 95% CI, 0.15-0.76, P = 0.008). Secondary cytoreductive surgery was also linked to longer progression-free survival (hazard ratio, 0.50; 95% CI, 0.30-0.84, P = 0.008). There was no evidence of a benefit of SCS in patients with unfavorable prognosis (P for interaction = 0.654).
Our results confirm the benefit of SCS in progression-free survival and overall survival in the recurrent setting and suggest that it exists not only for patients with a good prognosis.
二次减瘤手术（SCS）是治疗复发性卵巢癌患者的一种选择。三项正在进行的随机试验正在比较SCS加化疗与单纯化疗，且很少有比较研究发表。
我们对2000年至2013年在单一机构接受治疗的209例复发性卵巢癌患者的数据进行了回顾性分析。我们分析了复发情况下的预后因素，以通过多变量模型（包括倾向评分）按预后组确定SCS的价值。
在单变量分析中，年龄小于65岁、有乳腺癌或卵巢癌个人或家族史、诊断时为I-II期、初次肿瘤细胞减灭术后残留病灶10毫米或更小、体能状态为1或更低、CA125小于100、仅1个复发转移部位、无铂间期超过12个月以及SCS与更好的总生存期相关。在包括倾向评分的多变量模型中，SCS仍然与死亡风险降低66%相关（风险比，0.34；95%CI，0.15 - 0.76，P = 0.008）。二次减瘤手术还与更长的无进展生存期相关（风险比，0.50；95%CI，0.30 - 0.84，P = 0.008）。在预后不良的患者中没有证据表明SCS有获益（交互作用P = 0.654）。
我们的结果证实了SCS在复发情况下对无进展生存期和总生存期的益处，并表明不仅预后良好的患者存在这种益处。
