Rema P, John Elizabeth Reshmi, Samabasivan Suchetha, Prahladan Anil, George Preethi, Ranjith J Siva, Thomas Shaji
1Department of Surgical Oncology, Regional Cancer Centre, Thiruvanathapuram, Kerala India.
Department of Obstetrics and Gynecology, Azeezia Medical College Hospital, Meeyannoor, Kollam 37, Kerala, India.
Indian J Surg Oncol. 2019 Sep;10(3):426-434. doi: 10.1007/s13193-018-0868-x. Epub 2019 Jan 3.
The study aims at the prediction of optimal cytoreduction (OCR) in patients undergoing interval cytoreduction (ICR) in advanced epithelial ovarian cancer (AEOC) based on CT imaging and CA 125 values and assessing the survival pattern of these patients after ICR. This is a prospective observational study of patients with stage III C ovarian cancer who underwent ICR in our institution after neoadjuvant chemotherapy (NACT). All consecutive patients operated from April 2016 to October 2017 were included in the study. From their medical records, their demographic details and clinical variables were recorded. The CA 125 value and CT scan findings before and after chemotherapy were documented. A Bristow's predictive score (BS) was calculated based on the radiological parameters. After ICR, the outcome of the surgery was documented. Optimal cytoreduction (OCR) was defined as no gross residual disease after surgery. The surgical outcome was correlated with the CA 125 difference pre and post chemotherapy and Bristow's predictive score pre and post chemotherapy. The patients were followed up and their survival at 6 and 12 months was assessed. Univariate and multivariate analysis was done to identify factors predicting OCR. 51 patients were included in the study. Age group of the women ranged from 31 to 74 years with a mean of 52 years. Majority of the patients (70.6%) were postmenopausal. Of the 51 women, OCR could be achieved in 31 patients (60.8%). Post-chemotherapy, 36 patients had elevated CA125 above baseline of which 50% attained OCR. Forty six patients had CA 125 response post chemotherapy of which 67.4% attained OCR. Forty five patients had reduction in Bristow Score compared to the pre chemo values of which 64.4% attained OCR which was not found to be statistically significant. Overall survival was 100% survival at 6 months and 92.8% at 12 months in those who achieved OCR. Those with residual disease 0.1-1 cm had survival of 74.1% at 6 and 12 months. Those with residual disease > 1 cm had a survival of 50% at 6 and 12 months. CA125 response has a significant role in predicting OCR while CT evaluation using the BS was not useful in predicting OCR during ICR for AEOC.
本研究旨在基于CT成像和CA 125值预测晚期上皮性卵巢癌（AEOC）患者接受间歇性肿瘤细胞减灭术（ICR）时的最佳肿瘤细胞减灭（OCR）情况，并评估这些患者ICR后的生存模式。这是一项对III C期卵巢癌患者进行的前瞻性观察性研究，这些患者在新辅助化疗（NACT）后于我们机构接受ICR。2016年4月至2017年10月期间所有连续接受手术的患者均纳入本研究。从他们的病历中记录其人口统计学细节和临床变量。记录化疗前后的CA 125值和CT扫描结果。根据放射学参数计算布里斯托预测评分（BS）。ICR后，记录手术结果。最佳肿瘤细胞减灭（OCR）定义为术后无肉眼可见残留病灶。将手术结果与化疗前后的CA 125差值以及化疗前后的布里斯托预测评分进行关联分析。对患者进行随访并评估其6个月和12个月时的生存率。进行单因素和多因素分析以确定预测OCR的因素。51例患者纳入本研究。女性年龄范围为31至74岁，平均年龄52岁。大多数患者（70.6%）为绝经后女性。51例女性中，31例患者（60.8%）可实现OCR。化疗后，36例患者的CA125高于基线水平，其中50%实现了OCR。46例患者化疗后CA 125有反应，其中67.4%实现了OCR。45例患者的布里斯托评分较化疗前降低，其中64.4%实现了OCR，但未发现具有统计学意义。实现OCR的患者6个月时总生存率为100%，12个月时为92.8%。残留病灶为0.1 - 1 cm的患者6个月和12个月时生存率为74.1%。残留病灶>1 cm的患者6个月和12个月时生存率为50%。CA125反应在预测OCR方面具有重要作用，而在AEOC的ICR期间使用BS进行CT评估对预测OCR并无帮助。
