Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, China.
Department of Gynecology, Beijing Shijitan Hospital, Capital Medical University, China.
Biomed Res Int. 2021 Jun 22;2021:5533134. doi: 10.1155/2021/5533134. eCollection 2021.
The mainstay of treatment for advanced ovarian cancer is debulking surgery followed by chemotherapy that includes carboplatin and paclitaxel, but the prognosis is poor. This study is aimed at evaluating the efficacy and safety of cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS+HIPEC) as first-line surgical treatment in patients with advanced ovarian cancer (AOC).
FIGO stage III/IV AOC patients underwent CRS+HIPEC as first-line surgical treatment at our center from December 2007 to January 2020. The primary endpoint was survival, and the secondary endpoint was safety.
Among 100 patients, the median Karnofsky performance status (KPS) score was 80 (50-100), median peritoneal cancer index (PCI) was 19 (1-39), median completeness of cytoreduction (CC) score was 1 (0-3), number of organ regions removed was 4 (3-9), number of peritoneal regions removed was 4 (1-9), and number of anastomoses was 1 (0-4). The median follow-up was 36.8 months; 75 (75.0%) patients were still alive, and 25 (25.0%) had died. The median overall survival (mOS) was 87.6 (95% CI: 72.1-103.0) months, and the 1-, 2-, 3-, 4-, and 5-year survival rates were 94.1%, 77.2%, 68.2%, 64.2%, and 64.2%, respectively. Univariate analysis showed that better mOS correlated with an age ≤, KPS ≥ 80, ascites ≤ 1000 ml, PCI < 19, and CC score 0-1. Multivariate Cox analysis showed that CC was an independent factor for OS; patients who underwent CRS with a CC score 0-1 had a mPFS of 67.8 (95% CI: 48.3-87.4) months. The perioperative serious adverse event and morbidity rates were 4.0% and 2.0%, respectively.
CRS+HIPEC improves survival for AOC patients with acceptable safety at experienced high-volume centers. Stringent patient selection and complete CRS are key factors for better survival.
晚期卵巢癌的主要治疗方法是肿瘤细胞减灭术加含卡铂和紫杉醇的化疗，但预后较差。本研究旨在评估细胞减灭术加腹腔热灌注化疗（CRS+HIPEC）作为晚期卵巢癌（AOC）一线手术治疗的疗效和安全性。
2007 年 12 月至 2020 年 1 月，我院收治的FIGO 分期 III/IV 期 AOC 患者行 CRS+HIPEC 作为一线手术治疗。主要终点为生存，次要终点为安全性。
100 例患者中，卡氏功能状态评分（KPS）中位数为 80（50-100），腹膜癌指数（PCI）中位数为 19（1-39），肿瘤细胞减灭术完全程度评分（CC）中位数为 1（0-3），切除器官区域数中位数为 4（3-9），切除腹膜区域数中位数为 4（1-9），吻合口数中位数为 1（0-4）。中位随访时间为 36.8 个月；75 例（75.0%）患者仍存活，25 例（25.0%）死亡。中位总生存期（mOS）为 87.6（95%CI：72.1-103.0）个月，1、2、3、4、5 年生存率分别为 94.1%、77.2%、68.2%、64.2%和 64.2%。单因素分析显示，更好的 mOS 与年龄≤、KPS≥80、腹水≤1000ml、PCI<19 和 CC 评分 0-1 相关。多因素 Cox 分析显示，CC 是 OS 的独立因素；行 CC 评分 0-1 的 CRS 患者的 mPFS 为 67.8（95%CI：48.3-87.4）个月。围手术期严重不良事件和发病率分别为 4.0%和 2.0%。
在经验丰富的高容量中心，CRS+HIPEC 可提高 AOC 患者的生存率，且安全性可接受。严格的患者选择和完全的 CRS 是提高生存率的关键因素。
