Carboni Fabio, Federici Orietta, Sperduti Isabella, Zazza Settimio, Sergi Domenico, Corona Francesco, Valle Mario
Peritoneal Tumours Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy.
Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy.
Cancers (Basel). 2021 Jan 29;13(3):523. doi: 10.3390/cancers13030523.
Despite improvement in treatments, the peritoneum remains the primary site of relapse in most ovarian cancer cases. Patients who underwent cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from epithelial ovarian cancer were reviewed. Kaplan-Meier curves and multivariate Cox analyses were used to identify survival rates and prognostic factors. This study included 158 patients. The procedure was mostly performed for recurrent disease (46.8%) and high-grade serous carcinoma (58.2%). The median peritoneal cancer index was 14, and complete cytoreduction was obtained in 87.9% of cases. Grade IV morbidity occurred in 15.2% of patients, mostly requiring surgical reoperation, and one patient (0.6%) died within 90 days. The median follow-up was 63.5 months. The Kaplan-Meier 5-year overall survival (OS) and disease-free survival (DFS) rates were 42.1% and 24.3%, respectively. Multiple regression logistic analyses demonstrated that the completeness of cytoreduction (CC) score ( ≤ 0.0001), pancreatic resection ( ≤ 0.0001) and number of resections ( = 0.001) were significant factors influencing OS; whereas the CC score ( ≤ 0.0001) and diaphragmatic procedures ( = 0.01) were significant for DFS. The addition of hyperthermic intraperitoneal chemotherapy to standard multimodality therapy may improve outcomes in both primary and recurrent epithelial ovarian cancer without impairing early postoperative results, but the exact timing has not yet been established. Prospective randomized studies will clarify the role and indications of this approach.
尽管治疗方法有所改进，但在大多数卵巢癌病例中，腹膜仍是复发的主要部位。对因上皮性卵巢癌腹膜转移而接受细胞减灭术加腹腔内热化疗的患者进行了回顾性研究。采用Kaplan-Meier曲线和多变量Cox分析来确定生存率和预后因素。本研究纳入了158例患者。该手术主要用于复发性疾病（46.8%）和高级别浆液性癌（58.2%）。腹膜癌指数中位数为14，87.9%的病例实现了完全细胞减灭。15.2%的患者发生了IV级并发症，大多需要再次手术，1例患者（0.6%）在90天内死亡。中位随访时间为63.5个月。Kaplan-Meier法得出的5年总生存率（OS）和无病生存率（DFS）分别为42.1%和24.3%。多元回归逻辑分析表明，细胞减灭的完整性（CC）评分（≤0.0001）、胰腺切除术（≤0.0001）和切除次数（=0.001）是影响总生存率的重要因素；而CC评分（≤0.0001）和膈肌手术（=0.01）对无病生存率有显著影响。在标准多模式治疗中添加腹腔内热化疗可能会改善原发性和复发性上皮性卵巢癌的治疗效果，且不影响术后早期结果，但确切时机尚未确定。前瞻性随机研究将阐明这种方法的作用和适应证。
