Kumar Aalok, Le Nhu, Gilks C Blake, Santos Jennifer L, Wong Frances, Swenerton Kenneth, Hoskins Paul J, McAlpine Jessica N, Tinker Anna V
*BC Cancer Agency, Surrey Clinic, Surrey; and †Cancer Control, British Columbia Cancer Research Centre; ‡Cheryl Brown Ovarian Cancer Outcomes Unit, OvCaRe; §Vancouver General Hospital and University of British Columbia; and ∥BC Cancer Agency, Vancouver Clinic, Vancouver, British Columbia, Canada.
Int J Gynecol Cancer. 2017 Nov;27(9):1819-1825. doi: 10.1097/IGC.0000000000001124.
Our aim was to evaluate the population-based outcomes of stages I and II invasive ovarian mucinous carcinomas (MCs) treated with adjuvant platinum-based chemotherapy and abdominopelvic radiotherapy (XRT).
International Federation of Gynecology and Obstetrics stage I/II MC cases referred to the British Columbia Cancer Agency between 1984 and 2014 were reviewed. Chemotherapy (minimum of 3 cycles) and XRT were the institutional policy for stages IA/B (grade 2/3) and IC/II (any grade). Physician patterns of practice determined XRT use in eligible patients, allowing for the comparison of outcomes based on receipt of XRT treatment on disease-free survival (DFS) and overall survival (OS).
We identified 129 patients. Univariate analyses on substages IA, IC no rupture, IC with intraoperative rupture, and IC with preoperative rupture demonstrated 10-year DFS rates of 67%, 67%, 67%, and 27% (P = 0.004), respectively, and OS rates of 72%, 72%, 67%, and 38% (P = 0.01), respectively. For all patients, adjuvant XRT demonstrated improved 10-year DFS (78% vs 36%, P = 0.05) and OS (83% vs 36%, P = 0.02). Subgroup analysis did not detect a benefit of adjuvant therapy for stage IA grade 1/2. Multivariate analysis confirmed the benefit of XRT on DFS (hazard ratio, 0.14; 95% confidence interval, 0.02-0.98; P = 0.047) and a trend to improved OS (hazard ratio, 0.12; 95% confidence interval, 0.009-1.64; P = 0.11), whereas decision tree analysis demonstrated a reduced rate of relapse (33% vs 77%) and death (20% vs 46%) with the use of XRT, exclusive of patients with preoperative rupture.
This population-based retrospective study is the first to demonstrate that the use of adjuvant abdominopelvic XRT after chemotherapy can improve survival in patients diagnosed as having stage I/II MC. Patients with stage IA grade 1 and grade 2 MC can have adjuvant therapy omitted.
我们的目的是评估接受铂类辅助化疗和腹盆腔放疗（XRT）的Ⅰ期和Ⅱ期浸润性卵巢黏液性癌（MC）的基于人群的治疗结果。
回顾了1984年至2014年间转诊至不列颠哥伦比亚癌症机构的国际妇产科联盟Ⅰ/Ⅱ期MC病例。化疗（至少3个周期）和XRT是IA/B期（2/3级）和IC/II期（任何级别）的机构治疗策略。医生的治疗模式决定了符合条件的患者是否接受XRT治疗，从而能够比较接受XRT治疗与未接受XRT治疗的无病生存期（DFS）和总生存期（OS）的结果。
我们确定了129例患者。对IA期、IC期无破裂、IC期术中破裂和IC期术前破裂亚组的单因素分析显示，10年DFS率分别为67%、67%、67%和27%（P = 0.004），OS率分别为72%、72%、67%和38%（P = 0.01）。对于所有患者，辅助XRT显示10年DFS（78%对36%，P = 0.05）和OS（83%对36%，P = 0.02）有所改善。亚组分析未发现IA期1/2级患者辅助治疗的益处。多因素分析证实XRT对DFS有益（风险比，0.14；95%置信区间，0.02 - 0.98；P = 0.047），OS有改善趋势（风险比，0.12；95%置信区间，0.009 - 1.64；P = 0.11），而决策树分析显示使用XRT（不包括术前破裂患者）可降低复发率（33%对77%）和死亡率（20%对46%）。
这项基于人群的回顾性研究首次表明，化疗后使用辅助腹盆腔XRT可提高诊断为Ⅰ/Ⅱ期MC患者的生存率。IA期1级和2级MC患者可省略辅助治疗。
