Singh Sareena, Guetzko Megan, Resnick Kimberly
Division of Gynecologic Oncology, University Hospitals Case Medical Center, Cleveland, OH, United States.
Department of OB/GYN, University Hospitals Case Medical Center, Cleveland, OH, United States.
Gynecol Oncol. 2016 Nov;143(2):241-245. doi: 10.1016/j.ygyno.2016.09.004. Epub 2016 Sep 8.
The objective of this study was to identify preoperative characteristics of patients that experience a delay in initiation of adjuvant chemotherapy after primary debulking surgery for ovarian cancer.
MATERIALS/METHODS: We performed a retrospective review of patients with Stage II to IV high-grade epithelial ovarian, tubal, and peritoneal carcinoma who underwent primary debulking surgery followed by adjuvant chemotherapy from 2005 to 2013. Patients were divided into 2 groups: Control (those who received their first cycle of chemotherapy within 6weeks of debulking surgery) vs. chemotherapy delay (those who received their first cycle of chemotherapy at an interval >6weeks from primary debulking surgery). Relevant clinical variables and survival outcomes were compared between the 2 groups using standard statistical methods.
A total of 221 patients were included in the analyses - 169 (76.5%) were in the control group and 52 (23.5%) were in the chemo delay group. On multi-variate analysis, risk factors that were significantly associated with a delay in initiation in chemotherapy included: age >65, albumin <3.5, and high age-adjusted Charlson Comorbidity Index score. Delay in chemotherapy initiation was associated with a shorter progression-free (p=0.014) but not overall survival (p=0.19).
Delay in initiation of chemotherapy affected 23.5% of patients in our study population. Easily identifiable risk factors for chemotherapy delay exist that can help us pre-operatively identify patients for which neoadjuvant chemotherapy may be a better treatment option. Further study into prospective modeling with these identified risk factors is warranted.
本研究的目的是确定在卵巢癌初次肿瘤细胞减灭术后辅助化疗开始延迟的患者的术前特征。
材料/方法：我们对2005年至2013年期间接受初次肿瘤细胞减灭术并随后接受辅助化疗的II至IV期高级别上皮性卵巢癌、输卵管癌和腹膜癌患者进行了回顾性研究。患者分为两组：对照组（在肿瘤细胞减灭术后6周内接受首个化疗周期的患者）与化疗延迟组（在初次肿瘤细胞减灭术后间隔超过6周接受首个化疗周期的患者）。使用标准统计方法比较两组之间的相关临床变量和生存结果。
共有221例患者纳入分析——169例（76.5%）在对照组，52例（23.5%）在化疗延迟组。多变量分析显示，与化疗开始延迟显著相关的危险因素包括：年龄>65岁、白蛋白<3.5以及年龄调整后的Charlson合并症指数评分高。化疗开始延迟与无进展生存期缩短相关（p=0.014），但与总生存期无关（p=0.19）。
在我们的研究人群中，23.5%的患者化疗开始延迟。存在易于识别的化疗延迟危险因素，这有助于我们在术前识别可能更适合新辅助化疗的患者。有必要对这些已识别的危险因素进行前瞻性建模的进一步研究。
