复发性卵巢透明细胞癌二次手术后的肿瘤学结局。

Oncologic outcomes after secondary surgery in recurrent clear-cell carcinoma of the ovary.

机构信息

Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicime, Nagoya, Japan

Obstetrics and Gynecology, Toyohashi Municipal Hospital, Toyohashi, Japan.

出版信息

Int J Gynecol Cancer. 2019 Jun;29(5):910-915. doi: 10.1136/ijgc-2018-000142. Epub 2019 Mar 5.

DOI:10.1136/ijgc-2018-000142

PMID:30839284

Abstract

OBJECTIVE

Complete tumor resection is considered essential in the management of patients with ovarian clear-cell carcinoma. There is a debate regarding whether patients with recurrent ovarian clear-cell carcinoma benefit from secondary cytoreductive surgery.

METHODS

Details of patients with clear-cell carcinoma were collected by the Tokai Ovarian Tumor Study Group (Nagoya University Hospital and 13 affiliated institutions) and evaluated between January 1990 and December 2015. Histology was confirmed after central pathological review. The primary endpoint of the study was disease-free survival after secondary cytoreductive surgery. Distributions of events were evaluated using the χ test. Survival analysis was based on the Kaplan-Meier method. Survival curves were compared using the log-rank test. A value of p<0.05 was considered significant.

RESULTS

A total of 169 patients who underwent secondary cytoreductive surgery (N=25) or medical management (N=144) for recurrent clear-cell carcinoma were collected. The median age for patients undergoing secondary cytoreductive surgery was 50 years (range 35-66). Overall, 18 patients had complete resection. In patients who underwent secondary cytoreductive surgery, the median disease-free and post-recurrence survival periods were 10.9 months and 21.2 months, respectively. Moreover, among 18 patients who underwent complete resection, seven showed no evidence of disease during the observation periods. The median post-recurrence survival periods of patients with complete or incomplete resection were 30.1 months and 10.4 months, respectively (p=0.002). On stratification by the recurrence site, patients with intraperitoneal recurrence showed poorer post-recurrence survival than those with recurrence at other sites (p=0.016). However, comparison between the secondary cytoreductive surgery group versus the medical management group showed there was no difference in post-recurrence survival, even when considering complete tumor resection (p=0.114).

CONCLUSION

Patients with intraperitoneal recurrence or incomplete tumor resection had the worst survival after secondary cytoreductive surgery.

摘要

目的

完全肿瘤切除被认为是卵巢透明细胞癌患者治疗的关键。对于复发性卵巢透明细胞癌患者是否受益于二次细胞减灭术，存在争议。

方法

通过东海卵巢肿瘤研究组（名古屋大学医院和 13 家附属医院）收集透明细胞癌患者的详细信息，并于 1990 年 1 月至 2015 年 12 月进行评估。中心病理复查后确认组织学。本研究的主要终点是二次细胞减灭术后无病生存。采用卡方检验评估事件分布。生存分析基于 Kaplan-Meier 方法。采用对数秩检验比较生存曲线。p<0.05 认为差异有统计学意义。

结果

共收集了 169 例接受二次细胞减灭术（N=25）或药物治疗（N=144）治疗复发性透明细胞癌的患者。接受二次细胞减灭术的患者中位年龄为 50 岁（范围 35-66 岁）。总体而言，18 例患者达到完全切除。在接受二次细胞减灭术的患者中，无病和复发后生存的中位时间分别为 10.9 个月和 21.2 个月。此外，在 18 例完全切除的患者中，7 例在观察期间无疾病证据。完全或不完全切除患者的复发后生存的中位时间分别为 30.1 个月和 10.4 个月（p=0.002）。按复发部位分层，腹膜内复发患者的复发后生存较其他部位复发患者差（p=0.016）。然而，与二次细胞减灭术组与药物治疗组相比，即使考虑完全肿瘤切除，复发后生存也无差异（p=0.114）。