Chung Young Shin, Kim Yun-Ji, Lee Inha, Lee Jung-Yun, Nam Eun Ji, Kim Sunghoon, Kim Sang Wun, Kim Young Tae
Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.
PLoS One. 2017 Sep 5;12(9):e0183754. doi: 10.1371/journal.pone.0183754. eCollection 2017.
There is currently no consensus regarding the optimal number of chemotherapy cycles to be administered before and after interval debulking surgery (IDS) in patients with advanced ovarian cancer. This study aimed to evaluate the impact of the number of neoadjuvant chemotherapy (NAC) and postoperative adjuvant chemotherapy (POAC) cycles on the survival of patients with advanced ovarian cancer undergoing NAC/IDS/POAC.
We retrospectively reviewed data from 203 patients who underwent NAC/IDS/POAC at Yonsei Cancer Hospital between 2006 and 2016. All patients underwent taxane plus carboplatin chemotherapy for NAC and POAC. The patient outcomes were analyzed according to the number of NAC, POAC, and total chemotherapy (NAC+POAC) cycles.
Patients who received fewer than 6 cycles of total chemotherapy (n = 8) had poorer progression-free survival (PFS) and overall survival (OS) than those completing at least 6 cycles (p = 0.005 and p<0.001, respectively). Among patients who completed at least 6 cycles of total chemotherapy (n = 189), Kaplan-Meier analysis revealed no significant difference in either PFS or OS according to the number of NAC cycles (1-3 vs. ≥4; p = 0.136 and p = 0.267, respectively). Among patients who experienced complete remission after 3 cycles of POAC (n = 98), the addition of further POAC cycles did not improve the PFS or OS (3 vs. ≥4; p = 0.641 and p = 0.104, respectively).
IDS after 4 cycles of NAC may be a safe and effective option when completing 6 cycles of total chemotherapy. Furthermore, the addition of more than 3 cycles of POAC does not appear to influence the survival of patients achieving completion remission after 3 cycles of POAC.
目前，对于晚期卵巢癌患者在间歇性肿瘤细胞减灭术（IDS）前后应进行的最佳化疗周期数尚无共识。本研究旨在评估新辅助化疗（NAC）和术后辅助化疗（POAC）周期数对接受NAC/IDS/POAC的晚期卵巢癌患者生存的影响。
我们回顾性分析了2006年至2016年间在延世癌症医院接受NAC/IDS/POAC的203例患者的数据。所有患者在NAC和POAC中均接受紫杉烷加卡铂化疗。根据NAC、POAC和总化疗（NAC+POAC）周期数分析患者的预后。
接受少于6个周期总化疗的患者（n = 8）的无进展生存期（PFS）和总生存期（OS）比完成至少6个周期的患者差（分别为p = 0.005和p<0.001）。在完成至少6个周期总化疗的患者中（n = 189），Kaplan-Meier分析显示，根据NAC周期数（1-3 vs.≥4），PFS或OS均无显著差异（分别为p = 0.136和p = 0.267）。在3个周期POAC后达到完全缓解的患者中（n = 98），增加更多的POAC周期并未改善PFS或OS（3 vs.≥4；分别为p = 0.641和p = 0.104）。
当完成6个周期的总化疗时，4个周期NAC后的IDS可能是一种安全有效的选择。此外，增加超过3个周期的POAC似乎不会影响在3个周期POAC后实现完全缓解的患者的生存。
