Division of Gynecologic Oncology, Duke Cancer Institute, Durham, NC, United States of America.
Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Durham, NC, United States of America.
Gynecol Oncol. 2019 Mar;152(3):554-559. doi: 10.1016/j.ygyno.2018.12.011. Epub 2018 Dec 14.
To evaluate surgical complexity scores (SCS) and minimally invasive surgery (MIS) at interval debulking surgery (IDS) in advanced epithelial ovarian cancer (EOC) patients receiving neoadjuvant chemotherapy (NACT).
A multi-institutional study of NACT with IDS for advanced EOC was conducted. Demographic data were abstracted and SCS assigned based on IDS findings. Disease-specific overall survival (DSS) was defined as the time from completion of adjuvant chemotherapy to death due to disease. Cox proportional hazards regression models were used for univariate and multivariate survival analyses.
282 patients were identified; 80.5% had high-grade serous histology and 54.6% were <75 (median 63.9; range 34.1-84.8). Approximately 84% were optimally cytoreduced (61% R0; 23% <1 cm). In multivariate analyses, age 75+ (p ≤ 0.001), residual disease (>1 cm; p = 0.03), and SCS ≥ 3 (p = 0.04) were significantly predictive of worse DSS when morbidity and ASA score were also in the model. When optimally debulked was defined as R0, only age 75+ (<0.001) was significantly associated with decreased DSS. In the R0 cohort, SCS did not significantly predict DSS. However, subset analysis defining optimal ≤1 cm, revealed higher SCS was associated with a 1.6-fold increased risk of death (p = 0.02). Fifty-one patients underwent laparoscopic IDS. Twenty-four (47%) were converted to laparotomy to achieve optimal debulking in 21 patients (87.5%); while 25 had laparoscopic optimal cytoreduction (19/25 [76%] R0).
In women with advanced EOC treated with NACT, older age, SCS ≥ 3, and residual disease >1 cm at IDS were predictors of worse survival. MIS appears safe and feasible with acceptable optimal cytoreduction rates.
评估接受新辅助化疗（NACT）的晚期上皮性卵巢癌（EOC）患者在间隔减瘤术中的手术复杂度评分（SCS）和微创手术（MIS）。
进行了一项 NACT 联合晚期 EOC 间隔减瘤术的多机构研究。提取人口统计学数据并根据 IDS 结果分配 SCS。疾病特异性总生存期（DSS）定义为完成辅助化疗至因疾病死亡的时间。采用 Cox 比例风险回归模型进行单因素和多因素生存分析。
共纳入 282 例患者；80.5%为高级别浆液性组织学，54.6%年龄<75 岁（中位年龄 63.9；范围 34.1-84.8）。约 84%达到最佳减瘤（61% RO；23%<1cm）。多因素分析显示，年龄 75 岁以上（p≤0.001）、残留病灶（>1cm；p=0.03）和 SCS≥3（p=0.04）与当发病率和 ASA 评分也包含在模型中时更差的 DSS 显著相关。当最佳减瘤定义为 RO 时，只有年龄 75 岁以上（<0.001）与 DSS 降低显著相关。在 RO 队列中，SCS 与 DSS 无显著相关性。然而，将最佳定义为≤1cm 的亚组分析显示，更高的 SCS 与死亡风险增加 1.6 倍相关（p=0.02）。51 例患者接受了腹腔镜 IDS。24 例（47%）转为开腹以达到 21 例（87.5%）患者的最佳减瘤效果；而 25 例患者进行了腹腔镜下最佳肿瘤细胞减灭术（25 例中有 19 例（76%）RO）。
在接受 NACT 治疗的晚期 EOC 女性中，年龄较大、SCS≥3 以及 IDS 时残留病灶>1cm 是生存较差的预测因素。MIS 似乎安全可行，且具有可接受的最佳肿瘤细胞减灭术率。
