Rauh-Hain J Alejandro, Melamed Alexander, Wright Alexi, Gockley Allison, Clemmer Joel T, Schorge John O, Del Carmen Marcela G, Keating Nancy L
Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts3Division of Population Sciences, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
JAMA Oncol. 2017 Jan 1;3(1):76-82. doi: 10.1001/jamaoncol.2016.4411.
Uncertainty remains about the relative benefits of primary cytoreductive surgery (PCS) vs neoadjuvant chemotherapy (NACT) for advanced-stage epithelial ovarian cancer (EOC).
To compare overall survival of PCS vs NACT in a large national population of women with advanced-stage EOC.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of women with stage IIIC and IV EOC diagnosed between 2003 and 2011 treated at hospitals across the United States reporting to the National Cancer Data Base. We focused on patients 70 years or younger with a Charlson comorbidity index of 0 who were likely candidates for either treatment.
Initial treatment approach of PCS vs NACT, examined using an intent-to-treat analysis.
Overall survival, defined as months from cancer diagnosis to death or date of the last contact. We used propensity score matching to compare similar women who underwent PCS and NACT. The association of treatment approach with overall survival was assessed using the Kaplan-Meier method and the log-rank test. We assessed whether the findings were influenced by differences in the prevalence of an unobserved confounder, such as limited performance status (Eastern Cooperative Oncology Group 1-2), preoperative disease burden, and BRCA status.
Among 22 962 patients (mean [SD] age, 56.12 [9.38] years), 19 836 (86.4%) received PCS and 3126 (13.6%) underwent NACT. We matched 2935 patients treated with NACT with similar patients who received PCS. The median follow-up was 56.5 (95% CI, 54.5-59.2) months in the PCS group and 56.3 (95% CI, 54.5-59.8) months in the NACT group in the propensity-matched cohort. Among propensity score-matched groups, the median overall survival was 37.3 (95% CI, 35.2-38.7) months in the PCS group and 32.1 (95% CI, 30.8-34.1) months in the NACT group (P < .001). However, if the NACT group had a higher proportion of women with performance statuses of 1 to 2 compared with those who underwent PCS (60% vs 50%), the association of PCS and improved survival would not be statistically significant.
Primary cytoreductive surgery was associated with improved survival compared with NACT in otherwise healthy women with advanced-stage epithelial ovarian cancer aged 70 years or younger. The lower survival in women who received NACT could be explained by a higher prevalence of limited performance status in women undergoing NACT.
对于晚期上皮性卵巢癌（EOC），原发性细胞减灭术（PCS）与新辅助化疗（NACT）的相对获益仍不明确。
比较美国大量晚期EOC女性患者中PCS与NACT的总生存期。
设计、设置和参与者：对2003年至2011年间在美国各地医院诊断为IIIC期和IV期EOC的女性进行回顾性队列研究，这些医院向国家癌症数据库报告。我们关注年龄在70岁及以下、Charlson合并症指数为0且可能适合两种治疗的患者。
使用意向性分析检查PCS与NACT的初始治疗方法。
总生存期，定义为从癌症诊断到死亡或最后一次接触日期的月数。我们使用倾向评分匹配来比较接受PCS和NACT的相似女性。使用Kaplan-Meier方法和对数秩检验评估治疗方法与总生存期的关联。我们评估了研究结果是否受到未观察到的混杂因素（如有限的体能状态（东部肿瘤协作组1-2级）、术前疾病负担和BRCA状态）患病率差异的影响。
在22962例患者（平均[标准差]年龄，56.12[9.38]岁）中，19836例（86.4%）接受了PCS，3126例（13.6%）接受了NACT。我们将2935例接受NACT治疗的患者与接受PCS的相似患者进行匹配。在倾向匹配队列中，PCS组的中位随访时间为56.5（95%CI，54.5-59.2）个月，NACT组为56.3（95%CI，54.5-~59.8）个月。在倾向评分匹配组中，PCS组的中位总生存期为37.3（95%CI，35.2-38.7）个月，NACT组为32.1（95%CI，30.8-34.1）个月（P<0.001）。然而，如果NACT组中体能状态为1至2级的女性比例高于接受PCS的女性（60%对50%），则PCS与生存率提高之间的关联将无统计学意义。
在70岁及以下、其他方面健康的晚期上皮性卵巢癌女性中，原发性细胞减灭术与NACT相比可提高生存率。接受NACT的女性生存率较低可能是由于接受NACT的女性中有限体能状态的患病率较高。
