Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan.
Jpn J Clin Oncol. 2021 Aug 30;51(9):1407-1415. doi: 10.1093/jjco/hyab105.
The recent improvements in anti-cancer therapy following first-line treatment can potentially impact post-progression survival. We evaluated the factors that influence post-progression survival in advanced recurrent ovarian cancer.
Eighty-nine patients who underwent first-line treatment between June 2005 and December 2017 were included. The post-progression survival was defined as the difference between overall survival and initial progression-free survival. The effects of age, histology, stage, optimal surgery, secondary debulking surgery, bevacizumab administration, platinum sensitivity, and olaparib maintenance in recurrence were compared and independent risk factors were determined.
The median follow-up duration was 60.0 months (range: 2-181). Platinum-sensitive recurrence had longer post-progression survival than platinum-resistant (P < 0.001). Inclusion of bevacizumab in first-line treatment did not produce a significant difference in post-progression survival (P = 0.462). Secondary debulking surgery (P = 0.013), bevacizumab administration (P < 0.001), and olaparib maintenance (P = 0.001) during recurrence increased post-progression survival. In multivariate analysis, histologies other than serous or endometrioid (hazard ratio = 2.389; 95% confidence interval = 1.200-4.754; P = 0.013) and non-bevacizumab usage in recurrence (hazard ratio = 4.484; 95% confidence interval = 1.939-10.370; P < 0.001) were independently correlated with poorer prognosis. Bevacizumab administration beyond progressive disease elicited improved post-progression survival (P < 0.001). In patients receiving bevacizumab in first-line treatment, exclusion of bevacizumab in the recurrent therapy (hazard ratio = 5.507; 95% confidence interval = 2.301-12.124; P < 0.001) was independently correlated with poorer prognosis.
The continuous use of bevacizumab beyond progressive disease improves post-progression survival suggesting its important role in first-line and recurrence treatment for ovarian cancer.
一线治疗后抗癌治疗的近期改善可能会影响进展后生存。我们评估了影响晚期复发性卵巢癌进展后生存的因素。
纳入 2005 年 6 月至 2017 年 12 月期间接受一线治疗的 89 例患者。进展后生存定义为总生存与初始无进展生存的差异。比较年龄、组织学、分期、最佳手术、二次减瘤术、贝伐珠单抗治疗、铂类敏感性和复发性奥拉帕利维持治疗的影响，并确定独立的危险因素。
中位随访时间为 60.0 个月（范围：2-181）。铂类敏感复发的进展后生存时间长于铂类耐药（P<0.001）。一线治疗中包含贝伐珠单抗对进展后生存无显著影响（P=0.462）。二次减瘤术（P=0.013）、贝伐珠单抗治疗（P<0.001）和复发性奥拉帕利维持治疗（P=0.001）可延长进展后生存。多因素分析显示，非浆液性或子宫内膜样组织学（危险比=2.389；95%置信区间=1.200-4.754；P=0.013）和复发性贝伐珠单抗治疗（危险比=4.484；95%置信区间=1.939-10.370；P<0.001）与预后较差独立相关。贝伐珠单抗在疾病进展后继续使用可改善进展后生存（P<0.001）。在一线治疗中接受贝伐珠单抗治疗的患者中，复发性治疗中排除贝伐珠单抗（危险比=5.507；95%置信区间=2.301-12.124；P<0.001）与预后较差独立相关。
贝伐珠单抗在疾病进展后持续使用可改善进展后生存，表明其在卵巢癌一线和复发治疗中的重要作用。
