高级别和低级别晚期浆液性上皮性卵巢癌女性的预后
Outcomes of Women With High-Grade and Low-Grade Advanced-Stage Serous Epithelial Ovarian Cancer.
作者信息
Gockley Allison, Melamed Alexander, Bregar Amy J, Clemmer Joel T, Birrer Michael, Schorge John O, Del Carmen Marcela G, Rauh-Hain J Alejandro
机构信息
Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, and the Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, and the Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
出版信息
Obstet Gynecol. 2017 Mar;129(3):439-447. doi: 10.1097/AOG.0000000000001867.
OBJECTIVE
To compare outcomes of women with advanced-stage low-grade serous ovarian cancer and high-grade serous ovarian cancer and identify factors associated with survival among patients with advanced-stage low-grade serous ovarian cancer.
METHODS
A retrospective study of patients diagnosed with grade 1 or 3, advanced-stage (stage IIIC and IV) serous ovarian cancer between 2003 and 2011 was undertaken using the National Cancer Database, a large administrative database. The effect of grade on survival was analyzed using the Kaplan-Meier method. Factors predictive of outcome were compared using the Cox proportional hazards model. Among women with low-grade serous ovarian cancer, propensity score matching was used to compare all-cause mortality among similar women who underwent chemotherapy and lymph node dissection and those who did not.
RESULTS
A total of 16,854 (95.7%) patients with high-grade serous ovarian cancer and 755 (4.3%) patients with low-grade serous ovarian cancer were identified. Median overall survival was 40.7 months among high-grade patients and 90.8 months among women with low-grade tumors (P<.001). Among patients with low-grade serous ovarian cancer in the propensity score-matched cohort, the median overall survival was 88.2 months among the 140 patients who received chemotherapy and 95.9 months among the 140 who did not receive chemotherapy (P=.7). Conversely, in the lymph node dissection propensity-matched cohort, median overall survival was 106.5 months among the 202 patients who underwent lymph node dissection and 58 months among the 202 who did not (P<.001).
CONCLUSION
When compared with high-grade serous ovarian cancer, low-grade serous ovarian cancer is associated with improved survival. In patients with advanced-stage low-grade serous ovarian cancer, lymphadenectomy but not adjuvant chemotherapy was associated with improved survival.
目的
比较晚期低级别浆液性卵巢癌和高级别浆液性卵巢癌女性患者的预后，并确定晚期低级别浆液性卵巢癌患者生存的相关因素。
方法
利用大型管理数据库国家癌症数据库，对2003年至2011年间诊断为1级或3级、晚期（IIIC期和IV期）浆液性卵巢癌的患者进行回顾性研究。采用Kaplan-Meier法分析级别对生存的影响。使用Cox比例风险模型比较预测预后的因素。在低级别浆液性卵巢癌女性患者中，采用倾向评分匹配法比较接受化疗和淋巴结清扫的相似女性与未接受者的全因死亡率。
结果
共识别出16854例（95.7%）高级别浆液性卵巢癌患者和755例（4.3%）低级别浆液性卵巢癌患者。高级别患者的中位总生存期为40.7个月，低级别肿瘤女性患者为90.8个月（P<0.001）。在倾向评分匹配队列中的低级别浆液性卵巢癌患者中，140例接受化疗的患者中位总生存期为88.2个月，140例未接受化疗的患者为95.9个月（P=0.7）。相反，在淋巴结清扫倾向评分匹配队列中，202例接受淋巴结清扫的患者中位总生存期为106.5个月，202例未接受者为58个月（P<0.001）。
结论
与高级别浆液性卵巢癌相比，低级别浆液性卵巢癌患者生存情况更佳。在晚期低级别浆液性卵巢癌患者中，淋巴结切除术而非辅助化疗与生存期改善相关。
Zotero 插件