Crown Princess Mary Cancer Care Centre, Westmead Hospital, Sydney, NSW, Australia; The Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia.
Crown Princess Mary Cancer Care Centre, Westmead Hospital, Sydney, NSW, Australia; NHMRC Clinical Trials Centre, Sydney, NSW, Australia; Department of Gynecological Cancer, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.
Gynecol Oncol. 2016 Sep;142(3):458-64. doi: 10.1016/j.ygyno.2016.06.023. Epub 2016 Jul 18.
Primary peritoneal cancer is rare and considered equivalent to stage III/IV ovarian cancer, but questions remain concerning its underlying biology, prognosis and optimal management.
Clinico-pathological and treatment details of primary peritoneal (n=120) and ovarian cancer (n=635) were obtained on women recruited to the Australian Ovarian Cancer Study. Log-rank test was used to compare survival and cox proportional hazards models were fitted to obtain hazard ratios and 95% confidence intervals, both unadjusted and adjusted for age, grade, FIGO stage, residual disease and treatment with neoadjuvant chemotherapy. Molecular subtype was determined by gene expression profiling using published data.
Compared with advanced serous ovarian cancer, primary peritoneal cancer patients were older (mean age 65.5 vs. 60.2years, p<0.001), more often treated with neoadjuvant chemotherapy (38.4% vs. 11.4%, p<0.001). Gene expression profiling classified a substantially higher proportion of primary peritoneal carcinomas as C1 (mesenchymal, reactive stromal infiltration) subtype (70.6% vs. 32.1%, p=0.029), which was associated with lower complete surgical resection rate. Women with primary peritoneal cancer had significantly shorter progression-free (11.6 vs. 13.6months, p=0.007) and overall survival (31.7 vs. 39.8months, p=0.012). In multivariate analysis, residual disease and neoadjuvant chemotherapy were both independently associated with increased risk of progression and death.
Primary peritoneal cancer patients were more frequently treated with neoadjuvant chemotherapy and had inferior survival. Different tumor biology characterized by activated stromal fibrosis in primary peritoneal cancer may underlie the differences in treatment and clinical outcome.
原发性腹膜癌较为罕见，被认为与 III/IV 期卵巢癌相当，但关于其基础生物学、预后和最佳治疗方法仍存在疑问。
在澳大利亚卵巢癌研究中招募的女性中获得了原发性腹膜（n=120）和卵巢癌（n=635）的临床病理和治疗详细信息。使用对数秩检验比较生存情况，并拟合 Cox 比例风险模型以获得风险比和 95%置信区间，均未调整和调整年龄、分级、FIGO 分期、残留疾病和新辅助化疗治疗。使用已发表的数据通过基因表达谱确定分子亚型。
与晚期浆液性卵巢癌相比，原发性腹膜癌患者年龄更大（平均年龄 65.5 岁 vs. 60.2 岁，p<0.001），更常接受新辅助化疗（38.4% vs. 11.4%，p<0.001）。基因表达谱将更高比例的原发性腹膜癌分类为 C1（间质，反应性基质浸润）亚型（70.6% vs. 32.1%，p=0.029），这与完全手术切除率较低有关。原发性腹膜癌患者的无进展生存期（11.6 个月 vs. 13.6 个月，p=0.007）和总生存期（31.7 个月 vs. 39.8 个月，p=0.012）明显更短。多变量分析表明，残留疾病和新辅助化疗均与进展和死亡风险增加独立相关。
原发性腹膜癌患者更常接受新辅助化疗，生存情况较差。原发性腹膜癌不同的肿瘤生物学特征是基质纤维化激活，这可能是治疗和临床结果差异的基础。
