手术努力可能减轻 IIIC-IV 期不可切除卵巢癌新辅助化疗反应的差异：一项病例对照多机构研究。
Surgical Efforts Might Mitigate Difference in Response to Neoadjuvant Chemotherapy in Stage IIIC-IV Unresectable Ovarian Cancer: A Case-Control Multi-institutional Study.
机构信息
Gynecologic Oncology, IRCCS National Cancer Institute, Milan.
Medical Oncology, Ospedale degli Infermi, Faenza, Italy.
出版信息
Int J Gynecol Cancer. 2018 Nov;28(9):1706-1713. doi: 10.1097/IGC.0000000000001286.
OBJECTIVE
The aim of the study was to evaluate outcomes of patients with unresectable advanced ovarian cancer experiencing complete response (CR) to neoadjuvant chemotherapy.
METHODS
Data of consecutive patients undergoing neoadjuvant chemotherapy plus interval debulking surgery (IDS) were retrospectively reviewed in 4 Italian centers. Using a propensity-matching algorithm, we compared data of patients achieving CR with neoadjuvant chemotherapy (no macroscopic either microscopic residual disease (RD) at the time of IDS) with patients achieving partial response (PR). This latter group was stratified by the presence of RD (RD = 0 vs RD > 0).
RESULTS
Overall, 193 had IDS after neoadjuvant chemotherapy: 25 (13%), 81 (41.9%), and 74 (38.3%) patients had CR, PR with RD of 0, and PR with RD of more than 0, respectively. In addition, 13 (6.7%) patients had no macroscopic disease detected at DS but just microscopic disease at pathological examination. For the study purpose, 25 patients achieving CR were matched (1:2) with 50 patients having PR and RD of 0 and 50 patients having PR and RD of more than 0. As the result of propensity matching, baseline characteristics were similar between groups. Comparing survival outcomes of patients having CR and PR with RD of 0, we observed that type of response to chemotherapy did not influence disease-free (hazard ratio = 1.53 [95% confidence interval = 0.88-2.66], P = 0.127) and overall (hazard ratio = 1.74 [95% confidence interval = 0.76-4.01], P = 0.189) survivals. Patients achieving CR experienced significantly better disease-free survival (P = 0.004) and a trend toward better overall survival (P = 0.06) than patients achieving PR with RD of more than 0 at IDS.
CONCLUSIONS
Complete cytoreduction might mitigate the difference in response to neoadjuvant chemotherapy. The presence of RD at IDS is associated with worse survival outcomes.
目的
本研究旨在评估接受新辅助化疗后达到完全缓解（CR）的无法切除的晚期卵巢癌患者的结局。
方法
对 4 家意大利中心接受新辅助化疗加间隔减瘤手术（IDS）的连续患者的数据进行回顾性分析。使用倾向匹配算法，我们比较了新辅助化疗后达到 CR（IDS 时无肉眼或显微镜下残留病灶（RD））的患者与达到部分缓解（PR）的患者的数据。后者根据 RD 的存在进行分层（RD=0 与 RD>0）。
结果
共有 193 例患者接受新辅助化疗后行 IDS：25（13%）、81（41.9%）和 74（38.3%）例患者分别达到 CR、PR 且 RD=0 和 PR 且 RD>0。此外，13（6.7%）例患者在 IDS 时仅在病理检查中发现显微镜下疾病，但无肉眼疾病。为了进行研究目的，25 例达到 CR 的患者与 50 例 PR 且 RD=0 和 50 例 PR 且 RD>0 的患者进行了 1:2 匹配。由于倾向匹配，组间基线特征相似。比较达到 CR 和 PR 且 RD=0 的患者的生存结局，我们观察到化疗反应类型并不影响无疾病进展生存（危险比=1.53[95%置信区间=0.88-2.66]，P=0.127）和总生存（危险比=1.74[95%置信区间=0.76-4.01]，P=0.189）。与达到 PR 且 RD>0 的患者相比，达到 CR 的患者无疾病进展生存显著更好（P=0.004），总生存有改善趋势（P=0.06）。
结论
完全减瘤可能会减轻对新辅助化疗反应的差异。IDS 时 RD 的存在与较差的生存结局相关。
Zotero 插件