May Taymaa, Comeau Robyn, Sun Ping, Kotsopoulos Joanne, Narod Steven A, Rosen Barry, Ghatage Prafull
*Division of Gynecologic Oncology, Princess Margaret Cancer Center; †Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON; ‡Division of Gynecologic Oncology, Tom Baker Cancer Centre; §Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB; ∥Women's College Research Institute, Women's College Hospital; ¶Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; and #Beaumont Medical Group, Gynecologic Oncology, Royal Oak, MI.
Int J Gynecol Cancer. 2017 May;27(4):668-674. doi: 10.1097/IGC.0000000000000946.
The management of women with advanced-stage serous ovarian cancer includes a combination of surgery and chemotherapy. The choice of treatment with primary debulking surgery or neoadjuvant chemotherapy varies by institution. The objective of this study was to report 5-year survival outcomes for ovarian cancer patients treated at a single institution with primary debulking surgery or neoadjuvant chemotherapy.
This study included a retrospective chart review of 303 patients with stage IIIC or IV serous ovarian carcinoma diagnosed in Calgary, Canada. The patients were categorized into 1 of the 2 treatment arms: primary debulking surgery or neoadjuvant chemotherapy. The 5-year ovarian cancer-specific survival rates were estimated using Kaplan-Meier curves.
Among the 303 eligible patients, 142 patients (47%) underwent primary debulking surgery, and 161 patients (53%) were treated with neoadjuvant chemotherapy. Five-year survival was better for patients undergoing primary debulking surgery (39%) than for patients who received neoadjuvant chemotherapy (27%; P = 0.02). Women with no residual disease experienced better overall survival than those with any residual disease (47% vs. 26%, respectively; P = 0.0002). This difference was significant for those who had primary debulking surgery (P = 0.0004) but not for the patients who received neoadjuvant chemotherapy (P = 0.09). Women who received intraperitoneal chemotherapy had better overall survival as compared with patients who received intravenous chemotherapy (44% vs 30%, respectively; P = 0.002).
Our findings suggest that among women with no residual disease, survival is better among those who undergo primary debulking surgery than treatment with neoadjuvant chemotherapy. The latter should be reserved for women who are deemed not to be candidates for primary debulking surgery.
晚期浆液性卵巢癌女性患者的治疗包括手术和化疗相结合。选择初次肿瘤细胞减灭术还是新辅助化疗因机构而异。本研究的目的是报告在单一机构接受初次肿瘤细胞减灭术或新辅助化疗的卵巢癌患者的5年生存结果。
本研究包括对在加拿大卡尔加里诊断出的303例IIIC期或IV期浆液性卵巢癌患者进行回顾性病历审查。患者被分为两个治疗组之一：初次肿瘤细胞减灭术或新辅助化疗。使用Kaplan-Meier曲线估计5年卵巢癌特异性生存率。
在303例符合条件的患者中，142例（47%）接受了初次肿瘤细胞减灭术，161例（53%）接受了新辅助化疗。接受初次肿瘤细胞减灭术的患者5年生存率（39%）高于接受新辅助化疗的患者（27%；P = 0.02）。无残留病灶的女性总体生存率高于有任何残留病灶的女性（分别为47%和26%；P = 0.0002）。这种差异在接受初次肿瘤细胞减灭术的患者中具有统计学意义（P = 0.0004），但在接受新辅助化疗的患者中无统计学意义（P = 0.09）。与接受静脉化疗的患者相比，接受腹腔化疗的女性总体生存率更高（分别为44%和30%；P = 0.002）。
我们的研究结果表明，在无残留病灶的女性中，接受初次肿瘤细胞减灭术的患者生存率高于接受新辅助化疗的患者。后者应保留给被认为不适合进行初次肿瘤细胞减灭术的女性。
