Sun Hengzi, Bi Xiaoning, Cao Dongyan, Yang Jiaxin, Wu Ming, Pan Lingya, Huang Huifang, Chen Ge, Shen Keng
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,
Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Cancer Manag Res. 2018 Sep 12;10:3473-3482. doi: 10.2147/CMAR.S172687. eCollection 2018.
The aim of the study was to analyze the underlying causes and application of splenectomy in patients with epithelial ovarian cancer (EOC) and assess its effect on the surgical satisfaction and prognosis of these patients.
Clinical data of patients with ovarian epithelial cancer treated with cytoreductive surgery were collected from 2000 to 2015 at Peking Union Medical College Hospital.
A total of 2,882 patients underwent ovarian cancer cytoreductive surgery at Peking Union Medical College Hospital between 2000 and 2015, of whom 38 (1.3%) also underwent spleen resections. Of these 38 patients, one underwent splenectomy due to intraoperative trauma, whereas the remaining 37 patients underwent splenectomy due to splenic metastasis. Among these 37 patients, 27 underwent resection due to direct tumor spread in the spleen and 10 underwent resection due to hematogenous metastasis. For subsequent first-line chemotherapy, 22 patients were platinum sensitive and 15 were platinum resistant. Overall median survival and the postsplenectomy median survival time were 106 and 75 months, respectively. The overall median survival in secondary cytoreduction was 101 months compared with 20.3-56 months in literature reviews. Univariate analysis revealed that platinum resistance to first-line chemotherapy, suboptimal surgery, and hematogenous metastasis influenced survival. Chemosensitivity and residual disease were identified as independent risk factors by multivariate analysis. We also report a literature review concerning the efficacy and safety of splenectomy during cytoreductive surgery in EOC.
Approximately 1.3% of patients with EOC underwent spleen resection during initial cytoreductive surgery and more often during recytoreductive surgery. Tumor involvement was the most common indication for splenectomy, and rare patients underwent splenectomy due to intraoperative trauma. Most patients achieved optimal surgery, and thus their overall survival and postsplenectomy survival rates were longer. The prognosis of patients was closely related to chemosensitivity and presence of residual tumors. Splenectomy should be attempted in all patients with splenic involvement in whom optimal cytoreductive surgery was achievable, no matter in primary or secondary cytoreduction.
本研究旨在分析上皮性卵巢癌（EOC）患者脾切除术的潜在原因及应用情况，并评估其对这些患者手术满意度和预后的影响。
收集2000年至2015年在北京协和医院接受肿瘤细胞减灭术治疗的卵巢上皮癌患者的临床资料。
2000年至2015年期间，共有2882例患者在北京协和医院接受了卵巢癌肿瘤细胞减灭术，其中38例（1.3%）还接受了脾切除术。在这38例患者中，1例因术中创伤行脾切除术，其余37例因脾转移行脾切除术。在这37例患者中，27例因肿瘤直接蔓延至脾脏而接受切除，10例因血行转移而接受切除。对于后续的一线化疗，22例患者铂敏感，15例患者铂耐药。总体中位生存期和脾切除术后中位生存时间分别为106个月和75个月。二次肿瘤细胞减灭术的总体中位生存期为101个月，而文献综述中的生存期为20.3 - 56个月。单因素分析显示，一线化疗铂耐药、手术不彻底和血行转移影响生存。多因素分析确定化疗敏感性和残留病灶为独立危险因素。我们还报告了一篇关于EOC肿瘤细胞减灭术中脾切除术疗效和安全性的文献综述。
约1.3%的EOC患者在初次肿瘤细胞减灭术期间接受了脾切除术，在再次肿瘤细胞减灭术期间更为常见。肿瘤累及是脾切除术最常见的指征，因术中创伤行脾切除术的患者罕见。大多数患者实现了最佳手术，因此其总体生存率和脾切除术后生存率更长。患者的预后与化疗敏感性和残留肿瘤的存在密切相关。对于所有脾脏受累且能够实现最佳肿瘤细胞减灭术的患者，无论在初次还是二次肿瘤细胞减灭术中，均应尝试行脾切除术。
