新辅助化疗周期数增加对晚期上皮性卵巢癌肿瘤可切除性及病理反应的影响

Effect of increased number of neoadjuvant chemotherapy cycles on tumor resectability and pathologic response in advanced stage epithelial ovarian cancer.

作者信息

Akilli Huseyin, Rahatli Samed, Tohma Yusuf Aytac, Karakas Latife Atasoy, Altundag Ozden, Ayhan Ali

机构信息

Baskent University Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey.

出版信息

J BUON. 2018 Dec;23(7):111-115.

PMID:30722119

Abstract

PURPOSE

To identify the significance of the number of neoadjuvant chemotherapy (NACT) cycles on pathologic response and to define relationship between multiple cycles of NACT and the timing of interval debulking surgery (IDS) in epithelial ovarian cancer (EOC) patients.

METHODS

This retrospective case-control study was carried out at the Baskent University in Ankara between 2007 and 2017. We reviewed 62 patients with advanced stage (IIIC-IV) EOC who received NACT in other institutes and operated in our clinic. On the basis of the number of NACT cycles, patients were divided into 2 groups: group 1 received 3 cycles and group 2 received 4 to 6 cycles.The influence of the number of NACT cycles on complete pathologic response, lymph node involvement, overall survival (OS), progression free survival (PFS), platinum resistance and residual tumor were evaluated.

RESULTS

The median OS was 44.4 ±4.8 months and 48.8±4.49 months for group 1 and group 2 respectively (p=0.122). PFS was 19.3±3.75 months in group 1 and 24.3±4.67 months in group 2 (p=0.84). Tumor morphology according to lymph node involvement, no visible tumor and complete pathologic response were similar for both groups (p=0.49, p=0.79 and p=0.6 respectively). Pathological absence of residual disease were 13.6% vs 7.5% for group 1 and group 2 respectively (p=0.6) and total response rate was 6/62 (9.67%). Platinum resistance developed in 4 (18.2%) patients and 18(45%) patients in group1 and 2 respectively (p=0.031). Complete resection rates were similar for both groups (p=0.9). After multivariate survival analyses, complete resection remained significant (p=0.000, odds ratio/OR 2.28 [1.41-3.70]), and was independent of age, platinum resistance and number of NACT cycles. Complete resection rates were almost equal in each groups, (68.2% [15/22] and 67.5% [27/40] for group 1 and group 2 respectively (p=0.9)).

CONCLUSIONS

Our data suggests that giving more than 3 cycles of NACT is unnecessary because increased number of cycles did not change the resectability and complete pathologic response, while it increased platinum resistance. Moreover OS and PFS remained similar.

摘要

目的

确定新辅助化疗（NACT）周期数对病理反应的意义，并明确上皮性卵巢癌（EOC）患者多次NACT周期与间隔减瘤手术（IDS）时机之间的关系。

方法

这项回顾性病例对照研究于2007年至2017年在安卡拉的巴斯肯大学开展。我们回顾了62例晚期（IIIC-IV期）EOC患者，这些患者在其他机构接受了NACT并在我们诊所接受了手术。根据NACT周期数，患者被分为两组：第1组接受3个周期，第2组接受4至6个周期。评估NACT周期数对完全病理反应、淋巴结受累、总生存期（OS）、无进展生存期（PFS）、铂耐药性和残留肿瘤的影响。

结果

第1组和第2组的中位OS分别为44.4±4.8个月和48.8±4.49个月（p=0.122）。第1组的PFS为19.3±3.75个月，第2组为24.3±4.67个月（p=0.84）。两组在根据淋巴结受累情况的肿瘤形态、无可见肿瘤和完全病理反应方面相似（p分别为0.49、0.79和0.6）。第1组和第2组病理上无残留疾病的比例分别为13.6%和7.5%（p=0.6），总缓解率为6/62（9.67%）。第1组和第2组分别有4例（18.2%）和18例（45%）患者出现铂耐药（p=0.031）。两组的完全切除率相似（p=0.9）。多因素生存分析后，完全切除仍然具有显著性（p=0.000，比值比/OR为2.28[1.41-3.70]），且与年龄、铂耐药性和NACT周期数无关。每组的完全切除率几乎相等，第1组和第2组分别为68.2%（15/22）和67.5%（27/40）（p=0.9）。