Vermeulen Carolien K M, Tadesse Workineh, Timmermans Maite, Kruitwagen Roy F P M, Walsh Tom
Department of Gynaecologic Oncology, Mater Misericordiae University Hospital, Dublin, Ireland; Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands, The Netherlands.
Department of Gynaecologic Oncology, Mater Misericordiae University Hospital, Dublin, Ireland.
Eur J Obstet Gynecol Reprod Biol. 2017 Dec;219:100-105. doi: 10.1016/j.ejogrb.2017.10.019. Epub 2017 Oct 19.
The aim of this study was to compare surgical results and survival outcome of advanced ovarian cancer patients who were treated with primary versus interval debulking surgery.
In this retrospective study stage III and IV ovarian cancer patients who received debulking surgery from 2006 to 2015 were included. Surgical results were described as complete, optimal or suboptimal debulking and chi-square test was used to assess significant differences. Overall survival was measured using Kaplan-Meier curves, the log-rank test and uni- and multivariable Cox regression analyses.
Of 146 patients included in the study, 55 patients were treated with primary debulking surgery (PDS) followed by adjuvant chemotherapy and 91 patients received neoadjuvant chemotherapy (NAC) followed by interval debulking surgery (IDS). Complete or optimal debulking (0-10mm of residual disease) was achieved in 76.4% (n=42) of the PDS group and in 79.1% (n=72) of the IDS group. Overall median survival was 38 months for PDS and 31 months for IDS, which was not significantly different (p=0.181). In the IDS group, a significant difference was found in OS between complete and optimal resection (p=0.013). Besides that, no difference in survival outcome was found in the IDS group between patients with optimal or suboptimal debulking (median survival were 20 and 19 months respectively).
Complete debulking surgery is of utmost importance, both in case of PDS and IDS. Achieving optimal interval debulking of 1-10mm residual disease did not show any survival benefit over suboptimal interval debulking.
本研究旨在比较接受初次减瘤手术与间隔期减瘤手术的晚期卵巢癌患者的手术结果和生存结局。
在这项回顾性研究中，纳入了2006年至2015年接受减瘤手术的III期和IV期卵巢癌患者。手术结果被描述为完全、最佳或次优减瘤，并使用卡方检验评估显著差异。使用Kaplan-Meier曲线、对数秩检验以及单变量和多变量Cox回归分析来测量总生存期。
在纳入研究的146例患者中，55例患者接受了初次减瘤手术（PDS），随后进行辅助化疗，91例患者接受了新辅助化疗（NAC），随后进行间隔期减瘤手术（IDS）。PDS组76.4%（n = 42）的患者和IDS组79.1%（n = 72）的患者实现了完全或最佳减瘤（残留病灶0 - 10mm）。PDS组的总中位生存期为38个月，IDS组为31个月，差异无统计学意义（p = 0.181）。在IDS组中，完全切除和最佳切除之间的总生存期存在显著差异（p = 0.013）。除此之外，IDS组中最佳减瘤或次优减瘤患者的生存结局没有差异（中位生存期分别为20个月和19个月）。
无论是初次减瘤手术还是间隔期减瘤手术，完全减瘤手术都至关重要。实现1 - 10mm残留病灶的最佳间隔期减瘤与次优间隔期减瘤相比，未显示出任何生存获益。
