Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
Gynecol Oncol. 2019 Nov;155(2):192-200. doi: 10.1016/j.ygyno.2019.08.011. Epub 2019 Sep 12.
To determine if the primary treatment approach (primary debulking surgery (PDS) versus neoadjuvant chemotherapy and interval debulking surgery (NACT-IDS)) influences the pattern of first recurrence in patients with completely cytoreduced advanced high-grade serous ovarian carcinoma (HGSOC).
This retrospective study included 178 patients with newly diagnosed stage IIIC-IV HGSOC, complete gross resection during PDS (n = 124) or IDS (n = 54) from January 2008-March 2013, and baseline and first recurrence contrast-enhanced computed tomography scans. Clinical characteristics and number of disease sites at baseline were analyzed for associations with time to recurrence. In 135 patients who experienced recurrence, the overlap in disease locations between baseline and recurrence and the number of new disease locations at recurrence were analyzed according to the primary treatment approach.
At univariate and multivariate analyses, NACT-IDS was associated with more overlapping locations between baseline and first recurrence (p ≤ 0.003) and fewer recurrences in new anatomic locations (p ≤ 0.043) compared with PDS. The same results were found in a subgroup that received intra-peritoneal adjuvant chemotherapy after either treatment approach. At univariate analysis, patient age, primary treatment approach, adjuvant chemotherapy route, and number of disease locations at baseline were associated with time to recurrence (p ≤ 0.009). At multivariate analysis, older patient age, NACT-IDS, and greater disease locations at baseline remained significant (p ≤ 0.018).
The distribution of disease at the time of first recurrence varied with the choice of primary treatment. Compared to patients treated with PDS, patients who underwent NACT-IDS experienced recurrence more often in the same locations as the original disease.
确定初始治疗方法（原发性肿瘤细胞减灭术（PDS）与新辅助化疗和间隔性肿瘤细胞减灭术（NACT-IDS））是否会影响完全减瘤的晚期高级别浆液性卵巢癌（HGSOC）患者首次复发的模式。
本回顾性研究纳入了 178 例 2008 年 1 月至 2013 年 3 月期间新诊断为 IIIC-IV 期 HGSOC 的患者，这些患者在 PDS（n=124）或 IDS（n=54）期间实现了完全肉眼可见的肿瘤切除，且具有基线和首次复发的增强 CT 扫描。分析基线时的临床特征和疾病部位数量与复发时间之间的关系。在 135 例经历复发的患者中，根据初始治疗方法分析了基线和复发时疾病部位的重叠情况以及复发时新发病部位的数量。
单因素和多因素分析显示，与 PDS 相比，NACT-IDS 与基线和首次复发时更多的重叠部位（p≤0.003）和较少的新部位复发（p≤0.043）相关。在接受两种治疗方法中的任何一种治疗后的腹膜内辅助化疗的亚组中也得到了相同的结果。在单因素分析中，患者年龄、初始治疗方法、辅助化疗途径和基线时的疾病部位数量与复发时间相关（p≤0.009）。在多因素分析中，年龄较大、NACT-IDS 和基线时疾病部位较多与复发时间相关（p≤0.018）。
首次复发时疾病的分布随初始治疗方法的选择而变化。与接受 PDS 治疗的患者相比，接受 NACT-IDS 治疗的患者在与原发病灶相同的部位复发更为常见。
