Rajkumar Savithri, Nath Rahul, Lane Geoffrey, Mehra Gautam, Begum Shahina, Sayasneh Ahmad
Department of Gynaecological Oncology, Guy's and St Thomas' Hospital NHS Foundation Trust (GSTT), Westminster Bridge Road, London, SE1 7EH, United Kingdom.
Department of Gynaecological Oncology, Guy's and St Thomas' Hospital NHS Foundation Trust (GSTT), Westminster Bridge Road, London, SE1 7EH, United Kingdom.
Eur J Obstet Gynecol Reprod Biol. 2019 Mar;234:26-31. doi: 10.1016/j.ejogrb.2018.11.029. Epub 2018 Dec 21.
Primary aim of this study was to assess the impact of optimal cytoreduction in women who had surgical treatment of advanced stage (IIIC/IV) endometrial cancer. Secondary objective was to define demographic and surgico-pathologic variables that exerted a significant influence on survival outcomes.
Records of 45 patients with stage IIIC/IV Endometrial cancer who underwent surgery with cytoreductive intent between 2010 and 2016 were analysed. Data on disease distribution, surgical procedures, adjuvant therapy and survival times was collated. Survival curves were plotted by Kaplan Meier method and median survival estimates were compared using log rank test. Cox proportional hazards model was used to identify independent variables predictive of survival.
28 women (62.2%) had undergone primary surgery and 17 (37.8%) received neoadjuvant chemotherapy prior to delayed primary surgery. Optimal cytoreduction to </ = 1 cm visible disease was achieved in 29 women (64.4%). Among 29 women who had optimal debulking, 24 had no visible disease. Median overall survival for the entire study cohort was 24 months. Median progression free survival in the optimal cytoreduction group was 16 months as opposed to 11.5 months in women who had > 1 cm residual disease (p = 0.02). Median overall survival was 29 months in patients who had optimal cytoreduction and 17.5 months in women who had bulky residual disease (p=0.002). Only poor performance status (p = 0.035), presence of bowel disease (p = 0.05) and suboptimal cytoreduction (p = 0.006) retained significance as predictors of poor survival on multivariate analyses. Suboptimal cytoreduction surgery, compared to optimal cytoreduction, showed a 3.55-fold increased risk of death independent of performance status and anatomic region with disease (Hazard Ratio 3.55 (95% confidence interval 1.44-8.73) p = 0.006).
Survival analyses demonstrate significantly better progression free survival and overall survival when optimal cytoreduction is achieved. A prospective, multicentre study is recommended to establish conclusive evidence.
本研究的主要目的是评估晚期（IIIC/IV期）子宫内膜癌手术治疗女性患者中最佳肿瘤细胞减灭术的影响。次要目的是确定对生存结局有显著影响的人口统计学和手术病理变量。
分析了2010年至2016年间45例接受以肿瘤细胞减灭为目的手术的IIIC/IV期子宫内膜癌患者的记录。整理了疾病分布、手术方式、辅助治疗和生存时间的数据。采用Kaplan-Meier法绘制生存曲线，并使用对数秩检验比较中位生存估计值。使用Cox比例风险模型识别预测生存的独立变量。
28名女性（62.2%）接受了初次手术，17名（37.8%）在延迟初次手术前接受了新辅助化疗。29名女性（64.4%）实现了最佳肿瘤细胞减灭，使可见病灶≤1 cm。在29名实现最佳肿瘤细胞减灭的女性中，24名无可见病灶。整个研究队列的中位总生存期为24个月。最佳肿瘤细胞减灭组的中位无进展生存期为16个月，而残留病灶>1 cm的女性为11.5个月（p = 0.02）。实现最佳肿瘤细胞减灭的患者中位总生存期为29个月，残留病灶较大的女性为17.5个月（p = 0.002）。在多因素分析中，只有较差的体能状态（p = 0.035）、肠道疾病的存在（p = 0.05）和次优肿瘤细胞减灭（p = 0.006）作为不良生存的预测因素仍具有显著性。与最佳肿瘤细胞减灭相比，次优肿瘤细胞减灭手术显示出与体能状态和疾病解剖区域无关的3.55倍死亡风险增加（风险比3.55（95%置信区间1.44 - 8.73）p = 0.006）。
生存分析表明，实现最佳肿瘤细胞减灭时，无进展生存期和总生存期显著更好。建议进行一项前瞻性、多中心研究以确立确凿证据。
