Georgeena P, Rajanbabu Anupama, Vijaykumar D K, Pavithran K, Sundaram K R, Deepak K S, Sanal M R
Public Health Research Department, Amrita Institute of Medical Sciences, Kochi, Kerala 682041, India.
Department of Gynaecologic Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala 682041, India.
Ecancermedicalscience. 2016 Feb 4;10:619. doi: 10.3332/ecancer.2016.619. eCollection 2016.
To evaluate the treatment and survival pattern of patients with advanced epithelial ovarian cancer.
Retrospective study of all advanced epithelial ovarian cancer patients treated in the department of gynaecologic oncology from an academic centre, in a four year period from 1 January 2008-31 December 2011.
All patients with advanced epithelial ovarian cancer (stage III and IV) who underwent surgery from 2008-2011and had a follow-up of at least three months after completion of treatment were included. The decision on whether primary surgery or neoadjuvant chemotherapy (NACT) in advanced ovarian cancer was based on age, performance status, clinical and imaging findings.
A total of 178 cases of epithelial ovarian cancer were operated on during this four year period. Among them 28 patients were recurrent cases, 22 had early stages of ovarian cancer, and the rest 128 had stage III and IV ovarian cancer. In these 128 patients, 50(39.1%) underwent primary surgery and 78(60.9%) had NACT followed by surgery. In the primary surgery group 36(72.0%) patients had optimal debulking while in the NACT group 59(75.6%) patient had optimal debulking. With a median follow-up of 34 months, the median overall survival (OS) and progression free survival (PFS) was 53 and 49 months respectively. Patients who underwent primary surgery had better median PFS than patients who had NACT (56 months versus 39 months, p = 0.002). In stage III C the difference median PFS was significant for those treated with primary surgery when compared with NACT (55 months versus 39 months, p = 0.012). In patients who had optimal debulking to no residual disease (n = 90), primary surgery gave a significant improved PFS (59 months versus 38 months, p = 0.001) when compared with NACT. In univariate analysis, NACT was associated with increased risk of death (HR: 0.350; CI: 0.177-0.693).
In advanced epithelial ovarian cancer, primary surgery seems to have a definite survival advantage over NACT in patients who can be optimally debulked to no residual disease.
评估晚期上皮性卵巢癌患者的治疗及生存模式。
对某学术中心妇科肿瘤科室在2008年1月1日至2011年12月31日这四年期间治疗的所有晚期上皮性卵巢癌患者进行回顾性研究。
纳入所有在2008 - 2011年接受手术且治疗结束后至少随访三个月的晚期上皮性卵巢癌（III期和IV期）患者。晚期卵巢癌选择初次手术还是新辅助化疗（NACT）取决于年龄、体能状态、临床及影像学检查结果。
在这四年期间，共对178例上皮性卵巢癌患者进行了手术。其中28例为复发病例，22例为早期卵巢癌，其余128例为III期和IV期卵巢癌。在这128例患者中，50例（39.1%）接受了初次手术，78例（60.9%）先接受了NACT然后进行手术。在初次手术组中，36例（72.0%）患者实现了最佳肿瘤细胞减灭术，而在NACT组中，59例（75.6%）患者实现了最佳肿瘤细胞减灭术。中位随访时间为34个月，中位总生存期（OS）和无进展生存期（PFS）分别为53个月和49个月。接受初次手术的患者中位PFS优于接受NACT的患者（56个月对39个月，p = 0.002）。在III C期，与NACT相比，接受初次手术治疗的患者中位PFS差异显著（55个月对39个月，p = 0.012）。在实现最佳肿瘤细胞减灭至无残留病灶的患者（n = 90）中，与NACT相比，初次手术显著改善了PFS（59个月对38个月，p = 0.001）。单因素分析显示，NACT与死亡风险增加相关（HR：0.350；CI：0.177 - 0.693）。
在晚期上皮性卵巢癌中，对于能够实现最佳肿瘤细胞减灭至无残留病灶的患者，初次手术似乎比NACT具有明确的生存优势。
