Szczesny Witold, Langseth Hilde, Myklebust Tor Å, Kaern Janne, Tropé Claes, Paulsen Torbjørn
Department of Research, Innlandet Hospital Trust, Brumunddal, Norway.
Cancer Registry of Norway, Institute of Population-based Cancer Research, Oslo, Norway.
Acta Obstet Gynecol Scand. 2018 Aug;97(8):956-965. doi: 10.1111/aogs.13361. Epub 2018 May 22.
The aim of this study was to investigate whether secondary cytoreductive surgery and platinum-based chemotherapy improved survival among patients with recurrent, platinum-sensitive epithelial ovarian cancer compared with those who received platinum-based chemotherapy alone, and to identify possible predictors for selection to secondary cytoreductive surgery.
We included 397 patients who had a primary diagnosis of FIGO stage I-IV epithelial ovarian cancer recorded in the Cancer Registry of Norway between 1 January 2002 and 31 December 2012, received primary surgery with no residuals followed by platinum-based chemotherapy, had first recurrence six or more months after completion of primary platinum-based chemotherapy, and received secondary treatment with either secondary cytoreductive surgery and platinum-based chemotherapy (secondary cytoreductive surgery+platinum-based chemotherapy group) or platinum-based chemotherapy alone (platinum-based chemotherapy group). Outcomes were progression-free survival to second recurrence or death and overall survival. Hazard ratios were estimated using multivariable Cox regression.
There were 75 patients in the secondary cytoreductive surgery+platinum-based chemotherapy group in whom complete resection was achieved for 60 (80%), and 322 patients in the platinum-based chemotherapy group. Both progression-free survival (hazard ratio 0.45, 95% confidence interval 0.32-0.62) and overall survival (hazard ratio 0.50, 95% confidence interval 0.32-0.70) were improved in the secondary cytoreductive surgery+platinum-based chemotherapy compared with the platinum-based chemotherapy group. A survival benefit was only seen in patients with no residuals at secondary cytoreductive surgery.
In selected epithelial ovarian cancer patients with no residuals after primary surgery and a recurrent, platinum-sensitive tumor, the complete resection of recurrent tumor at secondary cytoreductive surgery improves progression-free survival and overall survival. Our results suggest that a long treatment-free interval and non-disseminated lesions (three or fewer lesions) on radiological images could be useful predictors for complete resection at secondary cytoreductive surgery.
本研究的目的是调查与单纯接受铂类化疗的患者相比，二次减瘤手术和铂类化疗是否能提高复发性铂敏感上皮性卵巢癌患者的生存率，并确定二次减瘤手术选择的可能预测因素。
我们纳入了397例患者，这些患者在2002年1月1日至2012年12月31日期间被挪威癌症登记处记录为初次诊断为FIGO I-IV期上皮性卵巢癌，接受了无残留的初次手术，随后接受铂类化疗，在初次铂类化疗完成后6个月或更长时间出现首次复发，并接受了二次治疗，治疗方式为二次减瘤手术加铂类化疗（二次减瘤手术+铂类化疗组）或单纯铂类化疗（铂类化疗组）。观察指标为至第二次复发或死亡的无进展生存期和总生存期。使用多变量Cox回归估计风险比。
二次减瘤手术+铂类化疗组有75例患者，其中60例（80%）实现了完全切除；铂类化疗组有322例患者。与铂类化疗组相比，二次减瘤手术+铂类化疗组的无进展生存期（风险比0.45，95%置信区间0.32-0.62）和总生存期（风险比0.50，95%置信区间0.32-0.70）均得到改善。仅在二次减瘤手术无残留的患者中观察到生存获益。
在初次手术后无残留且肿瘤复发、铂敏感的特定上皮性卵巢癌患者中，二次减瘤手术时对复发性肿瘤进行完全切除可改善无进展生存期和总生存期。我们的结果表明，较长的无治疗间期和影像学检查显示的非播散性病变（三个或更少病变）可能是二次减瘤手术完全切除的有用预测因素。
