Division of Gynecologic Oncology, Department of Obstetrics Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA.
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, MA.
Am J Obstet Gynecol. 2019 Dec;221(6):625.e1-625.e14. doi: 10.1016/j.ajog.2019.06.009. Epub 2019 Jun 14.
Most women with advanced epithelial ovarian cancer develop recurrent disease, despite maximal surgical cytoreduction and adjuvant platinum-based chemotherapy. In observational studies, secondary cytoreductive surgery has been associated with improved survival; however its use is controversial, because there are concerns that the improved outcomes may reflect selection bias rather than the superiority of secondary surgery.
To compare the overall survival of women with platinum-sensitive recurrent ovarian cancer treated at National Cancer Institute-designated cancer centers who receive secondary surgery vs chemotherapy.
This retrospective cohort study included women from 6 National Cancer Institute-designated cancer centers diagnosed with platinum-sensitive recurrent ovarian cancer between January 1, 2004, and December 31, 2011. The primary outcome was overall survival. Propensity score matching was used to compare similar women who received secondary surgery vs chemotherapy. Additional analyses examined how these findings may be influenced by the prevalence of unobserved confounders at the time of recurrence.
Among 626 women, 146 (23%) received secondary surgery and 480 (77%) received chemotherapy. In adjusted analyses, patients who received secondary surgery were younger (P = 0.001), had earlier-stage disease at diagnosis (P = 0.002), and had longer disease-free intervals (P < 0.001) compared with those receiving chemotherapy. In the propensity score-matched groups (n = 244 patients), the median overall survival was 54 months in patients who received secondary surgery and 33 months in those treated with chemotherapy (P < 0.001). Among patients who received secondary surgery, 102 (70%) achieved optimal secondary cytoreduction. There were no significant differences in complication rates between the 2 groups. In sensitivity analyses, the survival advantage associated with secondary surgery could be explained by the presence of more multifocal recurrences (if 4.3 times more common), ascites (if 2.7 times more common), or carcinomatosis (if 2.1 times more common) among patients who received chemotherapy instead of secondary surgery.
Patients with platinum-sensitive recurrent ovarian cancer who received secondary surgery had favorable surgical characteristics and were likely to have minimal residual disease following secondary surgery. These patients had a superior median overall survival compared with patients who received chemotherapy, although unmeasured confounders may explain this observed difference.
尽管进行了最大限度的手术减瘤和辅助铂类化疗，大多数患有晚期上皮性卵巢癌的女性仍会出现复发。在观察性研究中，二次细胞减灭术与生存改善相关；然而，其应用存在争议，因为人们担心改善的结果可能反映选择偏差而不是二次手术的优越性。
比较在国立癌症研究所指定癌症中心接受二线手术与化疗的铂敏感复发性卵巢癌女性的总生存。
本回顾性队列研究纳入了 6 家国立癌症研究所指定癌症中心在 2004 年 1 月 1 日至 2011 年 12 月 31 日期间诊断为铂敏感复发性卵巢癌的女性。主要结局为总生存。采用倾向评分匹配比较接受二线手术与化疗的相似女性。进一步分析检查这些发现如何受复发时未观察到的混杂因素的流行程度影响。
在 626 名女性中，146 名（23%）接受二线手术，480 名（77%）接受化疗。在调整分析中，与接受化疗的患者相比，接受二线手术的患者年龄更小（P=0.001）、诊断时疾病分期更早（P=0.002）且无疾病间隔时间更长（P<0.001）。在倾向评分匹配的两组（n=244 名患者）中，接受二线手术的患者中位总生存期为 54 个月，接受化疗的患者为 33 个月（P<0.001）。在接受二线手术的患者中，102 名（70%）达到了最佳二线细胞减灭术效果。两组的并发症发生率无显著差异。在敏感性分析中，与二线手术相关的生存优势可以通过以下因素解释：接受化疗而不是二线手术的患者中，多发病灶复发（如果更常见 4.3 倍）、腹水（如果更常见 2.7 倍）或癌性腹水（如果更常见 2.1 倍）的比例更高。
接受二线手术的铂敏感复发性卵巢癌患者具有有利的手术特征，并且在接受二线手术后可能具有最小的残留疾病。与接受化疗的患者相比，这些患者的中位总生存期更好，尽管未测量的混杂因素可能解释了这种观察到的差异。
