Department of Obstetrics and Gynecology, Seoul National University Hospital, Korea.
Department of Obstetrics and Gynecology, Dongguk University College of Medicine, Goyang, Korea.
Cancer Res Treat. 2022 Oct;54(4):1219-1229. doi: 10.4143/crt.2021.1010. Epub 2021 Nov 17.
This study aimed to identify patients who would benefit from third and subsequent lines of chemotherapy in recurrent epithelial ovarian cancer (EOC).
Recurrent EOC patients who received third, fourth, or fifth-line palliative chemotherapy were retrospectively analyzed. Patients' survival outcomes were assessed according to chemotherapy lines. Based on the best objective response, patients were divided into good-response (stable disease or better) and poor response (progressive disease or those who died before response assessment) groups. Survival outcomes were compared between the two groups, and factors associated with chemotherapy responses were investigated.
A total of 189 patients were evaluated. Ninety-four and 95 patients were identified as good and poor response group respectively, during the study period of 2008 to 2021. The poor response group showed significantly worse progression-free survival (median, 2.1 months vs. 9.7 months; p < 0.001) and overall survival (median, 5.0 months vs. 22.9 months; p < 0.001) compared with the good response group. In multivariate analysis adjusting for clinicopathologic factors, short treatment-free interval (TFI) (hazard ratio [HR], 5.557; 95% confidence interval [CI], 2.403 to 12.850), platinum-resistant EOC (HR, 2.367; 95% CI, 1.017 to 5.510), and non-serous/endometrioid histologic type (HR, 5.045; 95% CI, 1.152 to 22.088) were identified as independent risk factors for poor response. There was no difference in serious adverse events between good and poor response groups (p=0.167).
Third and subsequent lines of chemotherapy could be carefully considered for palliative purposes in recurrent EOC patients with serous or endometrioid histology, initial platinum sensitivity, and long TFIs from the previous chemotherapy regimen.
本研究旨在确定复发性上皮性卵巢癌（EOC）患者中哪些患者将从三线及后续化疗中获益。
回顾性分析接受三线、四线或五线姑息化疗的复发性 EOC 患者。根据化疗线数评估患者的生存结局。根据最佳客观缓解，患者分为缓解良好（疾病稳定或更好）和缓解不良（疾病进展或在缓解评估前死亡）两组。比较两组患者的生存结局，并探讨与化疗反应相关的因素。
共评估了 189 例患者。在 2008 年至 2021 年的研究期间，分别有 94 例和 95 例患者被确定为缓解良好和缓解不良组。与缓解良好组相比，缓解不良组的无进展生存期（中位数：2.1 个月比 9.7 个月；p<0.001）和总生存期（中位数：5.0 个月比 22.9 个月；p<0.001）明显更差。在调整临床病理因素的多变量分析中，较短的治疗无进展间期（HR，5.557；95%CI，2.403 至 12.850）、铂耐药性 EOC（HR，2.367；95%CI，1.017 至 5.510）和非浆液性/子宫内膜样组织学类型（HR，5.045；95%CI，1.152 至 22.088）被确定为缓解不良的独立危险因素。缓解良好和缓解不良组之间严重不良事件无差异（p=0.167）。
对于具有浆液性或子宫内膜样组织学、初始铂类敏感性和前一化疗方案治疗无进展间期较长的复发性 EOC 患者，可考虑三线及后续化疗作为姑息治疗的选择。
