Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Gynecol Oncol. 2021 Jan;160(1):51-55. doi: 10.1016/j.ygyno.2020.10.042. Epub 2020 Nov 17.
To describe oncologic outcomes after using acute normovolemic hemodilution (ANH) to reduce requirement for allogenic red blood cell transfusions (ABT) in patients undergoing primary debulking surgery (PDS) for advanced ovarian cancer.
We performed a post-hoc analysis of a recent prospective trial investigating the safety and feasibility of ANH during PDS for advanced ovarian cancer. We report long-term survival outcomes. We compared demographics, clinicopathological characteristics, survival outcomes in this cohort of Stage IIIB-IVB high-grade serous ovarian cancer patients undergoing ANH (ANH group), with a retrospective cohort of all other patients (standard group) undergoing PDS during the same time period (01/2012-04/2017). Standard statistical tests were used.
There were no demographic or clinicopathological differences between ANH (n = 33) and standard groups (n = 360), except for higher median age at diagnosis (57 vs. 62 years, respectively; p = 0.044) and shorter operative time (357 vs. 446 min, respectively; p < 0.001) in the standard group. Cytoreductive outcomes (ANH vs. standard): 0 mm, 69.7 vs. 63.9%; gross residual disease (RD) ≤1 cm, 21.2 vs. 26.9%; >1 cm, 9.1 vs. 9.2% (p = 0.78). RD after PDS was the only independent factor associated with worse progression-free survival (PFS) on multivariable analysis (p < 0.001). Patients with BRCA mutations trended towards improved PFS (p = 0.057). Significant factors for overall survival (OS) on multivariable analysis: preoperative CA125 (p = 0.004), ascites (p = 0.018), RD after PDS (p = 0.04), BRCA mutation status (p < 0.001). After adjustment for potential confounders, ANH was not independently associated with PFS or OS [PFS: HR 0.928 (0.618-1.395); p = 0.721; OS: HR 0.588 (95%CI: 0.317-1.092); p = 0.093].
ANH is an innovative approach in intraoperative management. It was previously proven to decrease need for ABT while maintaining the ability to achieve complete gross resection and associated benefits.
描述在接受高级别浆液性卵巢癌初次肿瘤细胞减灭术（PDS）的患者中使用急性等容血液稀释（ANH）减少异体红细胞输血（ABT）需求后肿瘤学结局。
我们对一项近期前瞻性研究进行了事后分析，该研究调查了在高级别浆液性卵巢癌的 PDS 中使用 ANH 的安全性和可行性。我们报告了长期生存结果。我们比较了在接受 ANH 的 IIIB-IVB 期高级别浆液性卵巢癌患者队列（ANH 组）和同一时期（2012 年 1 月至 2017 年 4 月）接受所有其他患者 PDS 的回顾性队列（标准组）的人口统计学、临床病理特征和生存结果。使用标准统计检验。
除了标准组的中位诊断年龄（57 岁 vs. 62 岁；p=0.044）和手术时间更短（357 分钟 vs. 446 分钟；p<0.001）外，ANH 组（n=33）和标准组（n=360）之间无人口统计学或临床病理差异。减瘤结果（ANH 组与标准组）：0mm，69.7% vs. 63.9%；残余肿瘤直径（RD）≤1cm，21.2% vs. 26.9%；>1cm，9.1% vs. 9.2%（p=0.78）。PDS 后 RD 是多变量分析中唯一与无进展生存期（PFS）较差相关的独立因素（p<0.001）。BRCA 突变患者的 PFS 趋势更好（p=0.057）。多变量分析中总生存期（OS）的显著因素：术前 CA125（p=0.004）、腹水（p=0.018）、PDS 后 RD（p=0.04）、BRCA 突变状态（p<0.001）。在调整潜在混杂因素后，ANH 与 PFS 或 OS 无独立相关性[PFS：HR 0.928（0.618-1.395）；p=0.721；OS：HR 0.588（95%CI：0.317-1.092）；p=0.093]。
ANH 是一种创新的术中管理方法。它以前被证明可以减少 ABT 的需求，同时保持完全大体切除的能力和相关益处。
