预测晚期高级别卵巢癌复发后个体生存的列线图。
Nomogram for Predicting Individual Survival After Recurrence of Advanced-Stage, High-Grade Ovarian Carcinoma.
机构信息
Cleveland Clinic Foundation and Case Western Reserve University, Cleveland, Ohio; NRG Oncology Statistics and Data Management Center, Roswell Park Cancer Institute, Buffalo, New York; The Ohio State University, Columbus, Ohio; the University of Minnesota, Minneapolis, Minnesota; Duke University Hospital; Durham, North Carolina; the University of California at Irvine, Orange, California; the University of Iowa Hospital, Iowa City, Iowa; Washington University in St. Louis School of Medicine, St. Louis, Missouri; ANZGOG, Australia-New Zealand Gynaecological Oncology Group, Sydney, Australia; the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Community Health Network and Indiana University School of Medicine, Indianapolis, Indiana; Walter Reed Army Medical Center; Bethesda, Maryland; Tacoma General Hospital, Tacoma, Washington; Moffitt Cancer Center, Tampa, Florida; the University of Colorado School of Medicine at Denver, Aurora, Colorado; Cancer Treatment Centers of America, Philadelphia Pennsylvania; NYU Clinical Cancer Center, New York, New York; Johns Hopkins University/Sidney Kimmel Cancer Center, Baltimore, Maryland; US Oncology Research, Arizona Oncology, Tucson, Arizona; the University of Pennsylvania Medical Center, Philadelphia, Pennsylvania; and The Ohio State University Medical Center, Columbus, Ohio.
出版信息
Obstet Gynecol. 2019 Feb;133(2):245-254. doi: 10.1097/AOG.0000000000003086.
OBJECTIVE
To analyze clinical prognostic factors for survival after recurrence of high-grade, advanced-stage ovarian-peritoneal-tubal carcinoma and to develop a nomogram to predict individual survival after recurrence.
METHODS
We retrospectively analyzed patients treated in multicenter Gynecologic Oncology Group protocols for stage III and IV ovarian-peritoneal-tubal carcinoma who underwent primary debulking surgery, received chemotherapy with paclitaxel and a platinum compound, and subsequently developed recurrence. Prognostic factors affecting survival were identified and used to develop a nomogram, which was both internally and externally validated.
RESULTS
There were 4,739 patients included in this analysis, of whom, 84% had stage III and 16% had stage IV ovarian carcinoma. At a median follow-up of 88.8 months (95% CI 86.2-92.0 months), the vast majority of patients (89.4%) had died. The median survival after recurrence was 21.4 months (95% CI 20.5-21.9 months). Time to recurrence after initial chemotherapy, clear cell or mucinous histology, performance status, stage IV disease, and age were significant variables used to develop a nomogram for survival after recurrence, which had a concordance index of 0.67. The time to recurrence alone accounted for 85% of the prognostic information. Similar results were found for patients who underwent second look laparotomy and had a complete pathologic response or received intraperitoneal chemotherapy.
CONCLUSION
For individuals with advanced-stage ovarian carcinoma who recur after standard first-line therapy, estimated survivals after recurrence are closely related to the time to recurrence after chemotherapy and prognostic variables can be used to predict subsequent survival.
CLINICAL TRIAL REGISTRATION
ClinialTrials.gov, NCT00002568, NCT00837993, NCT00002717, NCT01074398, and NCT00011986.
目的
分析高级别晚期卵巢-腹膜-输卵管癌复发后生存的临床预后因素，并建立预测个体复发后生存的列线图。
方法
我们回顾性分析了接受多中心妇科肿瘤学组 III 期和 IV 期卵巢-腹膜-输卵管癌治疗方案、接受紫杉醇和铂类化合物化疗、随后复发的患者。确定影响生存的预后因素，并用于开发列线图，该列线图进行了内部和外部验证。
结果
本分析共纳入 4739 例患者，其中 84%为 III 期，16%为 IV 期卵巢癌。中位随访 88.8 个月（95%CI 86.2-92.0 个月）后，绝大多数患者（89.4%）死亡。复发后中位生存时间为 21.4 个月（95%CI 20.5-21.9 个月）。初始化疗后复发时间、透明细胞或黏液组织学、表现状态、IV 期疾病和年龄是用于开发复发后生存列线图的重要变量，其一致性指数为 0.67。复发时间 alone 占预后信息的 85%。对于接受二次探查手术且完全病理缓解或接受腹腔内化疗的患者，也得到了类似的结果。
结论
对于接受标准一线治疗后复发的晚期卵巢癌患者，复发后的估计生存率与化疗后复发时间密切相关，预后变量可用于预测后续生存。
临床试验注册
ClinicalTrials.gov，NCT00002568，NCT00837993，NCT00002717，NCT01074398，和 NCT00011986。
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