Institute of Cancer and Genomic Sciences, College of Dental and Medical School, University of Birmingham, Edgbaston B15 2TT, United Kingdom.
Institute of Cancer and Genomic Sciences, College of Dental and Medical School, University of Birmingham, Edgbaston B15 2TT, United Kingdom; Pan Birmingham Gynaecological Cancer Centre, City Hospital, Birmingham B18 7QH, United Kingdom.
Gynecol Oncol. 2020 Jul;158(1):54-58. doi: 10.1016/j.ygyno.2020.04.048. Epub 2020 Apr 25.
The current standard of care for advanced high grade serous ovarian cancer (HGSC) comprises a combination of debulking surgery and platinum-based chemotherapy given in the neoadjuvant or adjuvant setting. In the neoadjuvant setting, patients usually undergo 3 cycles of chemotherapy followed by interval cytoreductive surgery (ICS), then 3 further cycles of chemotherapy. However, the optimum timeframe to administer chemotherapy before and after ICS remains unclear. We therefore examine the survival impact of the interval between pre- and post-operative chemotherapy in patients undergoing ICS in a well-established patient cohort. Factors leading to "delays" in recommencing post-operative chemotherapy were also examined.
The study comprises of a retrospective cohort of 205 cases with FIGO stage III and IV HGSC undergoing ICS. The duration of the interval between pre-operative and post-operative chemotherapy was correlated with progression-free (PFS) and overall survival (OS). Univariate and multivariate analyses were constructed to identify factors associated with survival and prolonged chemotherapy interruption.
The median interval between pre-operative and post-operative chemotherapy was 63 days. Multivariate analyses revealed macroscopic residual disease (HR:2.280, 95% CI:1.635-3.177, p ≤ 0.001) and interruption of chemotherapy >10 weeks (HR:1.65, 95%CI:1.201-2.290, p = 0.002) were associated with poorer OS. Existing medical comorbidities and longer hospital stay were independent prognostic factors for prolonging the chemotherapy interruption.
Our study recommends that interruption to chemotherapy to allow patients to undergo ICS should be ≤10 weeks; otherwise, OS is significantly impacted. Patients with pre-existing medical comorbidities should receive additional support pre- and post-operatively to keep the chemotherapy interruption to a minimum.
目前，高级别浆液性卵巢癌（HGSC）的标准治疗方法包括新辅助或辅助治疗中使用减瘤手术和铂类化疗的联合治疗。在新辅助治疗中，患者通常接受 3 个周期的化疗，然后进行间隔性细胞减灭术（ICS），然后再进行 3 个周期的化疗。然而，在 ICS 前后给予化疗的最佳时间框架仍不清楚。因此，我们在一个成熟的患者队列中研究了接受 ICS 的患者中化疗前后间隔时间对生存的影响。还检查了导致重新开始术后化疗“延迟”的因素。
该研究包括 205 例 FIGO 分期 III 期和 IV 期 HGSC 患者的回顾性队列，这些患者接受 ICS。术前和术后化疗之间的间隔时间与无进展生存期（PFS）和总生存期（OS）相关。进行了单变量和多变量分析，以确定与生存和延长化疗中断相关的因素。
术前和术后化疗之间的中位间隔时间为 63 天。多变量分析显示，宏观残留疾病（HR：2.280，95％CI：1.635-3.177，p≤0.001）和化疗中断> 10 周（HR：1.65，95％CI：1.201-2.290，p=0.002）与 OS 较差相关。现有的合并症和较长的住院时间是延长化疗中断的独立预后因素。
我们的研究建议，为允许患者接受 ICS 而中断化疗的时间应≤10 周；否则，OS 会受到显著影响。有预先存在的合并症的患者应在术前和术后接受额外的支持，以将化疗中断时间降至最低。
