Martinez A, Ngo C, Leblanc E, Gouy S, Luyckx M, Darai E, Classe J M, Guyon F, Pomel C, Ferron G, Filleron T, Querleu D
Department of Surgical Oncology, Institut Universitaire du Cancer-Oncopole, Toulouse, France.
Department of Surgical Oncology, Hôpital Georges Pompidou APHP, Paris, France.
Ann Surg Oncol. 2016 Aug;23(8):2515-21. doi: 10.1245/s10434-015-5069-z. Epub 2016 Mar 23.
The direct relationship between surgical radicality to compensate biologic behavior and improvement of patient outcome at the time of primary or interval cytoreduction remains unclear.
The aim of this study was to evaluate the impact of disease extension and surgical complexity on survival after complete macroscopic resection for stage IIIC-IV ovarian cancer.
Medical records from seven referral centers in France were reviewed to identify all patients who had complete cytoreductive surgery for stage IIIC-IV epithelial ovarian, fallopian, or primary peritoneal cancer. All patients had at least six cycles of carboplatin and paclitaxel combination therapy.
From the 374 consecutive patients with complete cytoreduction who were included in this study, stage, grade, upper abdominal disease, surgical complexity, and carcinomatosis extent were significantly associated with disease-free survival (DFS) at univariate analysis. Stage IV and the need for ultra-radical procedures were significantly associated with lower overall survival (OS). On multivariate analysis, radical surgery, including more than two visceral resections, was significantly associated with decreased DFS and OS.
Patients who need complex surgical procedures involving two or more visceral resections in order to achieve successful complete cytoreduction have worse outcome than patients with less extensive procedures. The negative impact of surgical complexity was not significant in patients who underwent upfront procedures. Tumor volume and extension were associated with decreased DFS in patients undergoing a primary surgical approach. This adds to the evidence that, even though complete cytoreduction is currently the objective of surgery, tumor load remains an independent poor prognostic factor and probably reflects a more aggressive behavior.
在初次或间隔期减瘤手术时，手术根治性与弥补生物学行为以及改善患者预后之间的直接关系仍不明确。
本研究旨在评估疾病范围扩展和手术复杂性对IIIC-IV期卵巢癌患者在进行完全肉眼切除术后生存情况的影响。
回顾了法国七个转诊中心的病历，以确定所有接受了IIIC-IV期上皮性卵巢癌、输卵管癌或原发性腹膜癌完全减瘤手术的患者。所有患者均接受了至少六个周期的卡铂和紫杉醇联合治疗。
在本研究纳入的374例连续接受完全减瘤手术的患者中，在单因素分析中，分期、分级、上腹部疾病、手术复杂性和癌灶范围与无病生存期（DFS）显著相关。IV期以及需要超根治性手术与较低的总生存期（OS）显著相关。在多因素分析中，包括超过两次内脏切除的根治性手术与DFS和OS降低显著相关。
为实现成功的完全减瘤而需要进行涉及两次或更多次内脏切除的复杂手术的患者，其预后比手术范围较小的患者更差。手术复杂性的负面影响在接受前期手术的患者中不显著。肿瘤体积和范围与接受初次手术的患者的DFS降低相关。这进一步证明，尽管目前完全减瘤是手术的目标，但肿瘤负荷仍然是一个独立的不良预后因素，可能反映了更具侵袭性的生物学行为。
