Drews F, Bertelli G, Lutchman-Singh K
Dept. of Gynaecological Oncology, Singleton Hospital, Swansea, United Kingdom.
Dept. of Oncology, Singleton Hospital, Swansea, United Kingdom.
Cancer Epidemiol. 2017 Aug;49:85-91. doi: 10.1016/j.canep.2017.05.014. Epub 2017 Jun 7.
This study represents the first reported outcomes for patients with advanced ovarian cancer (AOC) in South-West Wales undergoing treatment with primary debulking surgery or primary chemotherapy respectively.
This is a retrospective study of consecutive, unselected patients with advanced ovarian, fallopian tube or primary peritoneal cancer (FIGO III/IV) presenting to a regional cancer centre between October 2007 and October 2014. Patients were identified from Welsh Cancer Services records and relevant data was extracted from electronic National Health Service (NHS) databases. Main outcome measures were median overall survival (OS), progression free survival (PFS) and perioperative adverse events. Hazard ratio estimation was carried out with Cox Regression analysis and survival determined by Kaplan-Meier plots.
Of 220 women with AOC, 32.3% underwent primary debulking surgery (PDS) and 67.7% primary chemotherapy and interval debulking (PCT-IDS). Patients were often elderly (median age 67 years) with a poor performance status (26.5% PS >1). Complete cytoreduction (0cm residual) was achieved in 32.4% of patients in the PDS group and in 50.0% of patients undergoing IDS. Median OS for all patients was 21.9 months (PDS: 27.0 and PCT-IDS: 19.2 months; p >0.05) and median PFS was 13.1 months (PDS: 14.3 months and PCT-IDS: 13.0 months; p >0.05). Median overall and progression free survival for patients achieving complete cytoreduction were 48.0 and 23.2 months respectively in the PDS group and 35.4 months and 18.6 months in the IDS group (p >0.05).
This retrospective study of an unselected, consecutive cohort of women with AOC in South West Wales shows comparable survival outcomes with recently published trials, despite the relatively advanced age and poor performance status of our patient cohort. Over the seven-year study period, our data also demonstrated a non-significant trend towards improved survival following primary surgery in patients who achieved maximal cytoreduction. Our future aim therefore is to examine and develop the role of extended surgery in these patients.
本研究报告了在威尔士西南部分别接受初次肿瘤细胞减灭术或初次化疗的晚期卵巢癌（AOC）患者的首批治疗结果。
这是一项对2007年10月至2014年10月期间连续就诊于某地区癌症中心、未经挑选的晚期卵巢癌、输卵管癌或原发性腹膜癌（国际妇产科联盟（FIGO）III/IV期）患者的回顾性研究。通过威尔士癌症服务记录识别患者，并从电子国民健康服务（NHS）数据库中提取相关数据。主要观察指标为中位总生存期（OS）、无进展生存期（PFS）和围手术期不良事件。采用Cox回归分析进行风险比估计，并通过Kaplan-Meier曲线确定生存期。
在220例AOC女性患者中，32.3%接受了初次肿瘤细胞减灭术（PDS），67.7%接受了初次化疗及间隔期肿瘤细胞减灭术（PCT-IDS）。患者多为老年（中位年龄67岁），身体状况较差（26.5%的患者体能状态评分（PS）>1）。PDS组32.4%的患者以及接受间隔期肿瘤细胞减灭术的患者中50.0%实现了完全肿瘤细胞减灭（残留病灶0cm）。所有患者的中位OS为21.9个月（PDS组：27.0个月，PCT-IDS组：19.2个月；p>0.05），中位PFS为13.1个月（PDS组：14.3个月，PCT-IDS组：13.0个月；p>0.05）。在PDS组中，实现完全肿瘤细胞减灭的患者的中位总生存期和无进展生存期分别为48.0个月和23.2个月，在间隔期肿瘤细胞减灭术组中分别为35.4个月和18.6个月（p>0.05）。
这项对威尔士西南部未经挑选的连续AOC女性队列的回顾性研究表明，尽管我们的患者队列年龄相对较大且身体状况较差，但生存结果与近期发表的试验相当。在为期七年的研究期间，我们的数据还显示，实现最大程度肿瘤细胞减灭的患者接受初次手术后生存期有改善的趋势，但差异无统计学意义。因此，我们未来的目标是研究并拓展手术在这些患者中的作用。
