FIGO 分期Ⅰ期上皮性卵巢癌患者辅助化疗延迟与生存不良相关；基于国家癌症数据库的分析。

Delay in adjuvant chemotherapy administration for patients with FIGO stage I epithelial ovarian carcinoma is associated with worse survival; an analysis of the National Cancer Database.

机构信息

Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA.

出版信息

Gynecol Oncol. 2022 Aug;166(2):263-268. doi: 10.1016/j.ygyno.2022.05.015. Epub 2022 Jun 3.

DOI:10.1016/j.ygyno.2022.05.015

PMID:35667901

Abstract

OBJECTIVE

The administration of adjuvant chemotherapy within 42 days from surgery is one of the proposed quality measures for patients with epithelial ovarian cancer (EOC). The aim of the present study was to evaluate the impact of chemotherapy delay in the survival of patients with stage I EOC.

METHODS

The National Cancer Database was accessed, and patients diagnosed between 2004 and 2015 with FIGO stage I EOC who received multi-agent chemotherapy were identified. Overall survival (OS) was compared between patients who received chemotherapy <6 weeks and 6-12 weeks from surgery with the log-rank test following generation of Kaplan-Meier curves. Cox model was constructed to control for a priori selected confounders.

RESULTS

A total of 8549 patients who received adjuvant chemotherapy at a median 35 days from surgery (interquartile range 19) were identified; 67.7% received adjuvant chemotherapy <6 weeks from surgery while 32.3% experienced a delay. Patients who experienced a delay were more likely to have comorbidities (18.4% vs 14.9%, p < 0.001), and be managed in non-academic facilities (57.1% vs 53.2%, p = 0.001). Patients who experienced a delay had worse OS compared to those who did not, p < 0.001; 5-year OS rates 85.7% and 89.7%, respectively. For patients with high-grade serous tumors, those who experienced a delay had a 5-yr OS of 81.9% compared to 88.6% for those who did not, p < 0.001. After controlling for age, race, presence of comorbidities, insurance status, tumor histology and grade, performance of lymphadenectomy and substage, chemotherapy delay was associated with worse survival (HR: 1.25, 95% CI: 1.10, 1.42).

CONCLUSIONS

For patients with early stage EOC administration of adjuvant chemotherapy within 6 weeks from surgery was associated with better overall survival, especially for those with stage IC disease.

摘要

目的

在手术后 42 天内给予辅助化疗是上皮性卵巢癌（EOC）患者的一项拟议质量措施。本研究旨在评估化疗延迟对 I 期 EOC 患者生存的影响。

方法

访问国家癌症数据库，确定 2004 年至 2015 年间接受多药化疗的 FIGO Ⅰ期 EOC 患者。使用对数秩检验比较接受手术<6 周和 6-12 周化疗的患者的总生存率（OS），并生成 Kaplan-Meier 曲线。构建 Cox 模型以控制预先选择的混杂因素。

结果

共确定 8549 例接受中位数 35 天（四分位距 19）手术辅助化疗的患者；67.7%的患者在手术后<6 周接受辅助化疗，32.3%的患者出现化疗延迟。与未延迟的患者相比，延迟的患者更有可能合并症（18.4%比 14.9%，p<0.001），并且在非学术机构接受治疗（57.1%比 53.2%，p=0.001）。与未延迟的患者相比，延迟的患者 OS 更差，p<0.001；5 年 OS 率分别为 85.7%和 89.7%。对于高级别浆液性肿瘤患者，延迟组的 5 年 OS 为 81.9%，而未延迟组为 88.6%，p<0.001。在控制年龄、种族、合并症存在、保险状况、肿瘤组织学和分级、淋巴结切除术和亚分期、化疗延迟与较差的生存相关（HR：1.25，95%CI：1.10，1.42）。