Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
Medical Oncology, Ospedale degli Infermi, Faenza, Italy.
Eur J Obstet Gynecol Reprod Biol. 2019 Jun;237:93-99. doi: 10.1016/j.ejogrb.2019.04.007. Epub 2019 Apr 8.
Neoadjuvant chemotherapy plus interval debulking surgery is growing treatment strategy for advanced ovarian cancer patients with unresectable disease. Here, we aimed to assess predictors of surgical unresectability and survival of patients submitted to neoadjuvant chemotherapy plus interval debulking surgery.
Data of consecutive 193 patients undergoing neoadjuvant chemotherapy plus interval debulking surgery were retrospectively evaluated in four Italian oncologic centers. RECIST 1.1 guidelines were used to assess response to neoadjuvant chemotherapy. Survival outcomes were evaluated using Kaplan-Meier and Cox proportional hazard models.
Overall, 155 (80.3%) and 38 (19.7%) patients had optimal and non-optimal cytoreduction at the time of interval debulking surgery. Via multivariate analysis, age (OR: 2.87 (95%CI: 1.29, 6.36) per 10-year increase) and radiological response to neoadjuvant chemotherapy (OR: 48.1 (95%CI: 6.33, 365.3)) impact on the inability to perform a complete cytoreduction. Patients having complete or partial response experienced a significant better disease-free survival than patients having stable or progressive disease at radiological examination (median disease-free survival 16.8 vs. 11.0 months; HR: 0.42 (95%CI: 0.09, 0.78); p = .001). Radiological response did not predict for overall survival (p = .719).
RECIST1.1 response criteria might be helpful to predict surgical resectability and disease-free survival of advanced stage ovarian cancer patients undergoing neoadjuvant chemotherapy plus interval debulking surgery.
新辅助化疗加间隔减瘤术是治疗无法切除疾病的晚期卵巢癌患者的一种不断发展的治疗策略。在此，我们旨在评估接受新辅助化疗加间隔减瘤术的患者手术无法切除的预测因素和生存情况。
我们回顾性评估了四个意大利肿瘤中心的 193 例连续接受新辅助化疗加间隔减瘤术的患者的数据。RECIST 1.1 指南用于评估新辅助化疗的反应。使用 Kaplan-Meier 和 Cox 比例风险模型评估生存结果。
总体而言，155 例（80.3%）和 38 例（19.7%）患者在间隔减瘤术时有最佳和非最佳肿瘤细胞减灭术。通过多变量分析，年龄（每增加 10 岁，OR：2.87（95%CI：1.29，6.36））和新辅助化疗的放射学反应（OR：48.1（95%CI：6.33，365.3））对无法进行完全肿瘤细胞减灭术有影响。在影像学检查中表现为完全或部分缓解的患者比表现为稳定或进展性疾病的患者无疾病生存时间显著更长（中位无疾病生存时间 16.8 与 11.0 个月；HR：0.42（95%CI：0.09，0.78）；p=0.001）。放射学反应与总生存无关（p=0.719）。
RECIST1.1 反应标准可能有助于预测接受新辅助化疗加间隔减瘤术的晚期卵巢癌患者的手术可切除性和无病生存。
