Department of Surgical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse (IUCT), Oncopole, Toulouse, France.
Department of Surgical Oncology, Institut Bergonié, Bordeaux, France.
Gynecol Oncol. 2020 Sep;158(3):614-621. doi: 10.1016/j.ygyno.2020.06.495. Epub 2020 Jul 22.
To assess the survival benefit of primary debulking surgery (PDS) compared to interval debulking surgery (IDS) after complete cytoreduction (CC-0) or cytoreduction to minimal residual disease (CC-1) in advanced ovarian cancer. Secondary objective was to evaluate the effect of tumor load and surgical complexity on patients' survival.
A retrospective multicentric study was designed, including patients with IIIC-IV FIGO stage ovarian cancer who underwent PDS or IDS with CC-0 or CC-1 from January 2008 to December 2015 in four high-volume institutions. Patients were classified in three groups: PDS, IDS after 3-4 cycles of neoadjuvant chemotherapy (NACT), and IDS after 6 cycles. Disease-free survival (DFS) and overall survival (OS) were estimated. Univariable and multivariable analyses were conducted.
We included 549 patients, 175 (31.9%) underwent PDS, 224 (40.8%) had IDS after 3-4 cycles of NACT, and 150 (27.3%) underwent IDS after 6 cycles. Median DFS in PDS, IDS at 3-4 cycles and IDS at 6 cycles were 23.0 months (95%CI = [20.0-29.3]), 18.0 months (95%CI = [15.9-20.0]) and 17.1 months (95%CI = [15.0-20.9]), respectively; p < .001. Median OS were 84.0 months (95%CI = [68.3-111.0]), 50.7 months (95%CI = [44.6-59.5]) and 47.5 months (95%CI = [39.3-52.9]), respectively; p < .001. In multivariable analysis, high peritoneal cancer index score and NACT were negatively associated to DFS and OS. Surgical complexity and CC-1 were negatively associated to DFS.
PDS offered a survival gain of almost three years compared to IDS in patients with minimal or no residual disease after surgery. PDS should remain the standard of care for advanced ovarian cancer.
评估在完全细胞减灭术（CC-0）或减至最小残留病灶（CC-1）后，原发性肿瘤细胞减灭术（PDS）与间隔性肿瘤细胞减灭术（IDS）在晚期卵巢癌中的生存获益。次要目标是评估肿瘤负荷和手术复杂性对患者生存的影响。
设计了一项回顾性多中心研究，纳入了 2008 年 1 月至 2015 年 12 月在四家高容量机构接受 PDS 或 IDS 治疗、FIGO 分期 IIIC-IV 期卵巢癌且 CC-0 或 CC-1 的患者。患者被分为三组：PDS 组、IDS 组（NACT 后 3-4 个周期）和 IDS 组（NACT 后 6 个周期）。估计无病生存期（DFS）和总生存期（OS）。进行了单变量和多变量分析。
我们纳入了 549 名患者，其中 175 名（31.9%）接受了 PDS，224 名（40.8%）在 NACT 后 3-4 个周期进行了 IDS，150 名（27.3%）在 NACT 后 6 个周期进行了 IDS。PDS、IDS 后 3-4 个周期和 IDS 后 6 个周期的中位 DFS 分别为 23.0 个月（95%CI[20.0-29.3]）、18.0 个月（95%CI[15.9-20.0]）和 17.1 个月（95%CI[15.0-20.9]）；p<.001。中位 OS 分别为 84.0 个月（95%CI[68.3-111.0]）、50.7 个月（95%CI[44.6-59.5]）和 47.5 个月（95%CI[39.3-52.9]）；p<.001。多变量分析显示，高腹膜癌指数评分和 NACT 与 DFS 和 OS 呈负相关。手术复杂性和 CC-1 与 DFS 呈负相关。
与 IDS 相比，在手术后有最小或无残留疾病的患者中，PDS 提供了近 3 年的生存获益。PDS 应继续作为晚期卵巢癌的标准治疗方法。
