IC 期黏液性卵巢癌术后化疗的疗效。
Effectiveness of postoperative chemotherapy for stage IC mucinous ovarian cancer.
机构信息
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
出版信息
Gynecol Oncol. 2019 Sep;154(3):505-515. doi: 10.1016/j.ygyno.2019.06.021. Epub 2019 Jul 4.
OBJECTIVE
To examine the association between postoperative chemotherapy and survival of women with stage IC mucinous ovarian cancer (MOC).
METHODS
Comprehensive nationwide tumor registry data from the Commission on Cancer-accredited facilities in the United States from 2004 to 2014 were retrospectively examined. Women with stage IC MOC who underwent primary surgery followed by postoperative chemotherapy were compared to those who did not receive. Clinico-pathological factors associated with chemotherapy use, and overall survival associated with chemotherapy use were examined with multivariable models and propensity score inverse probability of treatment weighting (IPTW). External validation was performed by examining the Surveillance, Epidemiology, and End Results Program from 1988 to 2014.
RESULTS
There were 532 (58.5%) women who received postoperative chemotherapy and 377 (41.5%) women who did not. On multivariable analysis, those with moderately-/poorly-differentiated tumors, large tumor size, and who underwent lymphadenectomy were more likely to receive postoperative chemotherapy whereas young women and those with capsule rupture alone were less likely to receive postoperative chemotherapy (all, P < 0.05). After IPTW, there was no difference in overall survival among women who received postoperative chemotherapy versus those who did not on multivariable analysis (adjusted 4-year rates: 85.8% versus 86.3%, adjusted-hazard ratio [HR] 0.88, 95% confidence interval [CI] 0.60-1.31). Similarly, there was no benefit with chemotherapy regardless of patient age, tumor differentiation, performance of nodal dissection, and substage groups. Among 912 cases in the validation cohort (postoperative chemotherapy use, n = 520 [57.0%]), postoperative chemotherapy use was not associated with cause-specific survival (adjusted-HR 1.296, 95% CI 0.846-1.984, P = 0.233) or overall survival (adjusted-HR 1.131, 95% CI 0.849-1.508, P = 0.400).
CONCLUSION
Postoperative chemotherapy was received by fewer than 60% of women with stage IC MOC, and postoperative chemotherapy was not associated with improved survival.
目的
研究术后化疗与国际妇产科联盟（FIGO）分期为 IC 期黏液性卵巢癌（MOC）患者生存的关系。
方法
回顾性分析了美国癌症委员会认证机构 2004 年至 2014 年期间的全国肿瘤登记数据。比较了接受根治性手术和术后化疗的 IC 期 MOC 患者与未接受化疗的患者。采用多变量模型和倾向评分逆概率治疗加权（IPTW）分析了与化疗使用相关的临床病理因素以及与化疗使用相关的总生存情况。外部验证是通过检查 1988 年至 2014 年的监测、流行病学和最终结果（SEER）程序进行的。
结果
532 例（58.5%）患者接受了术后化疗，377 例（41.5%）患者未接受化疗。多变量分析显示，中/低分化肿瘤、肿瘤体积大以及进行淋巴结清扫的患者更有可能接受术后化疗，而年轻患者和仅存在包膜破裂的患者不太可能接受术后化疗（均 P＜0.05）。经 IPTW 校正后，多变量分析显示接受与未接受术后化疗的患者在总生存方面无差异（调整后的 4 年生存率：85.8%对 86.3%，调整后风险比[HR]0.88，95%置信区间[CI]0.60-1.31）。同样，无论患者年龄、肿瘤分化程度、是否进行淋巴结清扫以及亚分期如何，化疗均无获益。在验证队列的 912 例患者中（术后化疗使用情况，n=520[57.0%]），术后化疗与特定原因的生存（调整后 HR 1.296，95%CI 0.846-1.984，P=0.233）或总生存（调整后 HR 1.131，95%CI 0.849-1.508，P=0.400）均无关联。
结论
少于 60%的 IC 期 MOC 患者接受了术后化疗，且术后化疗与生存改善无关。
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