Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montréal, QC.
Division of Gynecologic Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montréal, QC.
J Obstet Gynaecol Can. 2020 Nov;42(11):1339-1345. doi: 10.1016/j.jogc.2020.04.014. Epub 2020 May 15.
To perform a hypothesis-generating evaluation of patient outcomes following neoadjuvant chemotherapy (NACT) compared with those following primary debulking surgery (PDS) in patients over age 75 with high-grade ovarian cancer.
This was a retrospective cohort study of consecutive patients aged 75 years and older, with high-grade ovarian cancer. Data were analyzed in SPSS 25.0 using descriptive statistics to characterize groups based on primary treatment modality, Kaplan-Meier survival curves to estimate overall and progression-free survival, and Cox proportional hazards to analyze confounders.
Of 429 patients with stages III and IV high-grade ovarian cancer (endometrioid and serous), 71 were aged older than 75 years and met our criteria for inclusion; 58 were treated with NACT while 13 underwent primary debulking. Sixteen patients did not undergo interval debulking following NACT. There were no significant differences in demographic characteristics between the groups. Following NACT, more patients were completely debulked-36.2% versus 21% (P = 0.000)-and had a shorter length of stay (5 vs. 7 d; P = 0.018). Overall survival was similar between the NACT and PDS groups (58.7 vs. 59.7 mo; LR -0.836; P = 0.361) despite lower progression-free survival in the NACT group (25.9 vs. 47.1 mo; P = 0.042; LR 4.31). Both progression-free and overall survival were significantly higher when patients undergoing NACT achieved complete debulking (21.7 and 102.3 mo, respectively) compared with suboptimal debulking (12.03 and 14.2 mo, respectively).
In this select group older patients with stage III and IV high-grade ovarian cancers, neoadjuvant chemotherapy may be considered without compromising outcomes and contributes to complete debulking.
在 75 岁以上患有高级别卵巢癌的患者中，与接受初始肿瘤细胞减灭术（PDS）相比，评估新辅助化疗（NACT）后患者的结局，并提出假说。
这是一项回顾性队列研究，纳入了年龄在 75 岁及以上的高级别卵巢癌患者。数据在 SPSS 25.0 中使用描述性统计进行分析，根据主要治疗方式对组进行特征描述，使用 Kaplan-Meier 生存曲线估计总生存和无进展生存，并使用 Cox 比例风险分析混杂因素。
在 429 例 III 期和 IV 期高级别卵巢癌（子宫内膜样和浆液性）患者中，有 71 例年龄大于 75 岁，符合纳入标准；58 例患者接受了 NACT，13 例患者接受了初始肿瘤细胞减灭术。16 例患者在接受 NACT 后未行间隔肿瘤细胞减灭术。两组患者的人口统计学特征无显著差异。在接受 NACT 后，更多的患者完全减瘤-36.2%与 21%（P=0.000），且住院时间更短（5 天与 7 天；P=0.018）。尽管 NACT 组的无进展生存时间更短（25.9 个月与 47.1 个月；LR=-0.836；P=0.361），但 NACT 和 PDS 两组患者的总生存时间相似（58.7 个月与 59.7 个月；LR-0.836；P=0.361）。在接受 NACT 的患者中，完全减瘤的患者的无进展生存（21.7 个月和 102.3 个月）和总生存（21.7 个月和 102.3 个月）明显高于不完全减瘤的患者（12.03 个月和 14.2 个月）。
在这个选择的高级别卵巢癌患者群体中，年龄较大的 III 期和 IV 期患者可以考虑使用新辅助化疗，而不会影响治疗效果，并有助于完全减瘤。
