Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
Gynecol Oncol. 2020 Dec;159(3):687-691. doi: 10.1016/j.ygyno.2020.09.011. Epub 2020 Sep 18.
To determine whether neoadjuvant chemotherapy (NACT) disproportionately benefits obese patients.
Data were collected from stage IIIC-IV ovarian cancer patients treated between 01/2010-07/2015. We performed univariate/multivariate logistic regression analyses with post-operative infection, readmission, any postoperative complication, and time to chemotherapy as outcomes. An interaction term was included in models, to determine if the effect of NACT on post-operative complications was influenced by obesity status.
Of 507 patients, 115 (22.6%) were obese and 392 (77.3%) were non-obese (obese defined as BMI ≥30). Among obese patients undergoing primary debulking surgery (PDS) vs. NACT, rates of postoperative infection were 42.9% vs. 30.8% (p = 0.12), 30-day readmission 30.2% vs. 11.5% (p < 0.02), and any post-operative complication were 44.4% vs 30.8% (p = 0.133). Among non-obese patients undergoing PDS vs. NACT, rates of post-operative infection were 20.0% vs. 12.9% (p = 0.057), 30-day readmission 16.9% vs. 9.2% (p = 0.02), and any post-operative complication were 19.4% vs 28% (p = 0.044). Obesity was associated with post-operative infection (OR 2.3; 95%CI 1.22-4.33), 30-day readmission/reoperation (OR 2.27; 95%CI 1.08-3.21) and the development of any post-operative complication (OR 2.1; CI 1.13-3.74). However, there was not a significant interaction between obesity and NACT in any of the models predicting post-operative complications.
The decision to use NACT should not be predicated on obesity alone, as the reduction in post-operative complications in obese patients is similar to non-obese patients.
确定新辅助化疗（NACT）是否对肥胖患者有利。
数据来自于 2010 年 1 月至 2015 年 7 月期间接受治疗的 IIIC-IV 期卵巢癌患者。我们对术后感染、再入院、任何术后并发症以及化疗时间作为结局进行了单变量/多变量逻辑回归分析。在模型中加入了一个交互项，以确定 NACT 对术后并发症的影响是否受肥胖状况的影响。
在 507 名患者中，115 名（22.6%）为肥胖，392 名（77.3%）为非肥胖（肥胖定义为 BMI≥30）。在接受初次肿瘤细胞减灭术（PDS）与 NACT 的肥胖患者中，术后感染发生率分别为 42.9%和 30.8%（p=0.12），30 天再入院率分别为 30.2%和 11.5%（p<0.02），任何术后并发症发生率分别为 44.4%和 30.8%（p=0.133）。在接受 PDS 与 NACT 的非肥胖患者中，术后感染发生率分别为 20.0%和 12.9%（p=0.057），30 天再入院率分别为 16.9%和 9.2%（p=0.02），任何术后并发症发生率分别为 19.4%和 28%（p=0.044）。肥胖与术后感染（OR 2.3；95%CI 1.22-4.33）、30 天再入院/再手术（OR 2.27；95%CI 1.08-3.21）和任何术后并发症的发生（OR 2.1；CI 1.13-3.74）相关。然而，在预测术后并发症的任何模型中，肥胖与 NACT 之间没有显著的相互作用。
不能仅根据肥胖状况决定是否使用 NACT，因为肥胖患者术后并发症的减少与非肥胖患者相似。
