Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Department of Clinical Science Lund, Skåne University Hospital, Lund University, Lund, Sweden;
Division of Oncology, Department of Clinical Science Lund, Skåne University Hospital, Lund University, Lund, Sweden.
Anticancer Res. 2022 May;42(5):2541-2551. doi: 10.21873/anticanres.15732.
BACKGROUND/AIM: Residual disease (RD) after primary debulking surgery (PDS) is a prognostic factor for survival in advanced ovarian cancer (AOC). This study aimed to examine whether the tumor extent affects overall survival (OS) and progression-free survival (PFS) in AOC patients treated with PDS.
A total of 118 patients treated with PDS were included. Age, ECOG score, AOC International Federation of Gynecology and Obstetrics (FIGO) stage, CA-125, RD, peritoneal cancer index (PCI), preoperative imaging (CT-PCI) and macroscopic visualization at the surgery start (S-PCI) were analyzed. Tumor extent was quantified using the PCI, and by CT-PCI and S-PCI. Cox regression, Kaplan-Meier and receiver operating curves (ROC) were performed for survival analyses.
S-PCI correlated with both OS (1.067, 95%CI=1.018-1.119, p<0.007) and PFS. Patients exhibiting S-PCI≥18.5, adjusted to age, performance status, and RD, had a two-fold risk of dying (HR=2.070, 95%CI=1.061-4.038, p=0.033) compared those with PCI<18.5. CT-PCI correlated with OS in crude data (1.037, 95%CI=1.005-1.071, p=0.025), but this was not sustained in multivariate analyses. RD of any size doubled the risk of dying (2.177, 95%CI=1.235-3.838, p=0.007).
The tumor extent at the beginning of surgery seemed to affect OS in patients with AOC, regardless of the extent of RD at the end of the surgery. PCI above 18.5 doubled the risk of dying of the disease. No difference in major complications was noted in the two groups of patients. CT-PCI seemed to play a prognostic role for PFS; however, it is still to be investigated as a prognostic factor for OS.
背景/目的：原发性减瘤术后（PDS）的残留疾病（RD）是晚期卵巢癌（AOC）患者生存的预后因素。本研究旨在探讨 PDS 治疗的 AOC 患者的肿瘤范围是否影响总生存（OS）和无进展生存（PFS）。
共纳入 118 例接受 PDS 治疗的患者。分析了年龄、ECOG 评分、AOC 国际妇产科联合会（FIGO）分期、CA-125、RD、腹膜癌指数（PCI）、术前影像学（CT-PCI）和手术开始时的宏观可视化（S-PCI）。使用 PCI、CT-PCI 和 S-PCI 量化肿瘤范围。进行 Cox 回归、Kaplan-Meier 和接收者操作曲线（ROC）进行生存分析。
S-PCI 与 OS（1.067，95%CI=1.018-1.119，p<0.007）和 PFS 均相关。调整年龄、表现状态和 RD 后，S-PCI≥18.5 的患者死亡风险增加两倍（HR=2.070，95%CI=1.061-4.038，p=0.033），而 PCI<18.5 的患者则无此风险。CT-PCI 在粗数据中与 OS 相关（1.037，95%CI=1.005-1.071，p=0.025），但在多变量分析中并未持续存在。任何大小的 RD 都会使死亡风险增加一倍（2.177，95%CI=1.235-3.838，p=0.007）。
手术开始时的肿瘤范围似乎影响 AOC 患者的 OS，而与手术结束时 RD 的范围无关。PCI 高于 18.5 会使死亡风险增加一倍。两组患者的主要并发症无差异。CT-PCI 似乎对 PFS 具有预后作用；然而，它作为 OS 的预后因素仍有待进一步研究。
