Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States.
Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, United States.
Gynecol Oncol. 2019 Oct;155(1):58-62. doi: 10.1016/j.ygyno.2019.08.004. Epub 2019 Aug 8.
To evaluate the impact of an evidence-based triage algorithm to decide between primary debulking surgery (PDS) and neoadjuvant chemotherapy followed by interval debulking surgery (NACT/IDS) for advanced epithelial ovarian cancer (EOC).
Surgical morbidity and mortality (M/M) after PDS for stage IIIC-IV EOC at Mayo Clinic after implementation of the triage algorithm (contemporary cohort, 2012-July 2016) were compared to that of a historic PDS cohort (2003-2011).
Mean age of the 232 women who met inclusion criteria in the contemporary cohort was 63.9 years. We observed a 71% decrease in 90-day mortality from 8.9% to 2.6% (P = 0.002) between the contemporary and historic cohorts. Accordion grade 3+ postoperative complications within 30 days after surgery decreased from 22.3% to 18.3% (P = 0.19). Among those with a grade 3+ complication, 90-day mortality rates decreased from 28.3% in the historic cohort to 2.4% in the contemporary cohort (P < 0.001) suggesting patients were better able to tolerate complex surgery. When compared to the historic PDS cohort, oncologic outcomes were also improved in the contemporary PDS cohort. Complete as well as optimal (residual disease ≤1 cm) cytoreduction rates increased (45.5% vs. 62.5% and 84.5% vs. 95.3%, respectively, P < 0.001), and the proportion of women starting chemotherapy within 42 days of surgery increased (57.4% vs. 69.8%, P = 0.001). Three-year overall survival was 53% in the historic cohort and 66% in the contemporary cohort (P < 0.001).
Use of the Mayo triage algorithm for EOC was associated with reduced 90-day mortality after PDS and improved oncologic outcomes. Surgical risk assessment is a critical aspect of treatment planning in the primary management of EOC and should be incorporated into practice.
评估基于循证的分诊算法对原发性减瘤手术（PDS）和新辅助化疗后间隔减瘤手术（NACT/IDS）治疗晚期上皮性卵巢癌（EOC）的影响。
比较梅奥诊所采用分诊算法后（当代队列，2012 年 7 月至 2016 年）治疗 IIIC-IV 期 EOC 患者后 PDS 的手术发病率和死亡率（M/M）与历史 PDS 队列（2003 年至 2011 年）。
当代队列中符合纳入标准的 232 名女性的平均年龄为 63.9 岁。与历史队列相比，当代队列中 90 天死亡率从 8.9%降至 2.6%（P=0.002），下降了 71%。术后 30 天内的阿科德 3+级并发症从 22.3%降至 18.3%（P=0.19）。在出现 3+级并发症的患者中，90 天死亡率从历史队列的 28.3%降至当代队列的 2.4%（P<0.001），表明患者能够更好地耐受复杂手术。与历史 PDS 队列相比，当代 PDS 队列的肿瘤学结局也得到了改善。完全减瘤术和最佳（残留病灶≤1cm）减瘤术的比例均有所提高（分别为 45.5%比 62.5%和 84.5%比 95.3%，P<0.001），且开始化疗的患者比例在 42 天内增加（分别为 57.4%比 69.8%，P=0.001）。历史队列的 3 年总生存率为 53%，当代队列为 66%（P<0.001）。
梅奥分诊算法在 EOC 中的应用与 PDS 后 90 天死亡率降低和肿瘤学结局改善相关。手术风险评估是 EOC 初始治疗计划中治疗的关键方面，应纳入实践。
