IIIC期至IV期上皮性卵巢癌患者在初次肿瘤细胞减灭术加化疗或新辅助化疗后行中间型肿瘤细胞减灭术达到完全缓解后的复发模式及临床结局：一项意大利多中心回顾性研究
Patterns of Recurrence and Clinical Outcome of Patients With Stage IIIC to Stage IV Epithelial Ovarian Cancer in Complete Response After Primary Debulking Surgery Plus Chemotherapy or Neoadjuvant Chemotherapy Followed by Interval Debulking Surgery: An Italian Multicenter Retrospective Study.
作者信息
Gadducci Angiolo, Cosio Stefania, Zizioli Valentina, Notaro Sara, Tana Roberta, Panattoni Andrea, Sartori Enrico
机构信息
*Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa (Italy); and †Department of Gynecology and Obstetrics, University of Brescia, Brescia, Italy.
出版信息
Int J Gynecol Cancer. 2017 Jan;27(1):28-36. doi: 10.1097/IGC.0000000000000843.
OBJECTIVE
The objective of this retrospective study was to assess the clinical outcome of patients with advanced epithelial ovarian cancer in complete response after primary debulking surgery (PDS) or neoadjuvant chemotherapy followed by interval debulking surgery (IDS]).
METHODS
The authors reviewed the hospital records of 384 patients who underwent PDS (n = 322) or IDS (n = 62) and who were in complete response after primary treatment.
RESULTS
Optimal (residual disease [RD] < 1 cm) and complete (no gross RD) cytoreduction rates were higher after IDS than after PDS (71.0% vs 55.9%; P = 0.001 and 51.6% vs 35.7%, respectively; P = 0.02). Tumor recurred in 73.0% of the 322 complete responders after PDS versus 87.1% of the 62 complete responders after IDS (P = 0.01). The IDS group showed a higher recurrence rate within 6 months (11.3% vs 3.1%: P = 0.01) and a trend to higher recurrence rate between 6 and 12 months (30.6% vs 19.9%). Tumor recurred in 57.4% of the 115 completely cytoreduced patients after PDS versus 87.5% of the 32 completely cytoreduced patients after IDS (P = 0.001). The IDS group showed a trend to higher recurrence rate within 6 months (6.2% vs 1.7%) and a higher recurrence rate between 6 and 12 months (37.5% vs 15.6%; P = 0.01). Two-year, 5-year, and 7-year progression-free survival were 65.8%, 40.8%, and 39.3% for completely cytoreduced patients after PDS versus 43.8%, 12.5%, and 12.5% for completely cytoreduced patients after IDS (P = 0.001); and 2-year, 5-year, and 7-year overall survival were 96.4%, 69.3%, and 50.4% for the former versus 87.1%, 41.8%, and 32.6% for the latter (P = 0.001).
CONCLUSIONS
The clinical outcome of completely cytoreduced patients was significantly better for PDS group than for IDS group, and therefore, the achievement of no gross RD after surgery seemed to have a different prognostic relevance for the 2 groups.
目的
本回顾性研究的目的是评估晚期上皮性卵巢癌患者在接受初次肿瘤细胞减灭术（PDS）或新辅助化疗后行中间性肿瘤细胞减灭术（IDS）且达到完全缓解后的临床结局。
方法
作者回顾了384例行PDS（n = 322）或IDS（n = 62）且在初始治疗后达到完全缓解的患者的医院记录。
结果
IDS后的最佳（残留病灶[RD]<1 cm）和完全（无肉眼可见RD）肿瘤细胞减灭率高于PDS后（分别为71.0%对55.9%；P = 0.001和51.6%对35.7%；P = 0.02）。PDS后322例完全缓解患者中有73.0%肿瘤复发，而IDS后62例完全缓解患者中有87.1%肿瘤复发（P = 0.01）。IDS组在6个月内的复发率更高（11.3%对3.1%：P = 0.01），且在6至12个月之间有复发率更高的趋势（30.6%对19.9%）。PDS后115例肿瘤完全减灭的患者中有57.4%肿瘤复发，而IDS后32例肿瘤完全减灭的患者中有87.5%肿瘤复发（P = 0.001）。IDS组在6个月内有复发率更高的趋势（6.2%对1.7%），且在6至12个月之间的复发率更高（37.5%对15.6%；P = 0.01）。PDS后肿瘤完全减灭的患者的2年、5年和7年无进展生存率分别为65.8%、40.8%和39.3%，而IDS后肿瘤完全减灭的患者分别为43.8%、12.5%和12.5%（P = 0.001）；前者的2年、5年和7年总生存率分别为96.4%、69.3%和50.4%，后者分别为87.1%、41.8%和32.6%（P = 0.001）。
结论
PDS组肿瘤完全减灭患者的临床结局明显优于IDS组，因此，手术实现无肉眼可见RD对两组似乎具有不同的预后意义。
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