Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa, USA.
Acta Obstet Gynecol Scand. 2022 Oct;101(10):1085-1092. doi: 10.1111/aogs.14415. Epub 2022 Jul 2.
The survival benefits of surgical cytoreduction in ovarian cancer are well-established. However, the surgical outcome has never been assessed while controlling for the efficacy of chemotherapy. This leaves the possibility that cytoreduction may not be beneficial for patients whose cancer does not respond well to adjuvant treatment. We sought to answer whether surgical cytoreduction independently improves overall survival when controlling for chemotherapy outcome.
We performed a retrospective case-control study using our institution's ovarian cancer database to evaluate the effect of optimal cytoreduction on advanced stage, high-grade serous ovarian cancer. Patients' characteristics were compared using both univariate and multivariate regression modeling to assess for independent predictors of overall survival.
A total of 470 patients were assessed for inclusion; 234 responders to chemotherapy and 98 nonresponders. Significant survival characteristics were identified and included in the multivariate analysis. Independent predictors of survival in the multivariate analysis were age, responder status, optimal cytoreduction, neoadjuvant chemotherapy, and number of chemotherapy cycles. Kaplan-Meier survival curves showed improved survival for both patients who responded to chemotherapy and for those undergoing optimal cytoreduction (p < 0.001). We also demonstrated improved survival for patients receiving optimal cytoreduction among both nonresponders and responders (p < 0.001).
Our analysis shows that patients who undergo optimal cytoreduction have an overall survival benefit regardless of their response to chemotherapy. Therefore, cytoreduction should be considered in all patients, even in those with advanced disease, if an optimal result can be achieved. This study was underpowered to assess patients who received neoadjuvant chemotherapy as a separate subgroup, but the order of treatment was controlled for in the overall analysis.
手术减瘤术在卵巢癌中的生存获益已得到充分证实。然而，在控制化疗疗效的情况下，尚未评估手术结果。这使得那些对辅助治疗反应不佳的癌症患者的肿瘤减灭术可能没有益处。我们试图回答在控制化疗结果的情况下，肿瘤减灭术是否能独立改善总体生存率。
我们使用本机构的卵巢癌数据库进行回顾性病例对照研究，以评估最佳肿瘤减灭术对晚期、高级别浆液性卵巢癌的影响。使用单变量和多变量回归模型比较患者特征，以评估总体生存率的独立预测因素。
共评估了 470 例患者，其中 234 例对化疗有反应，98 例无反应。确定了显著的生存特征，并纳入多变量分析。多变量分析中的独立生存预测因素包括年龄、反应状态、最佳肿瘤减灭术、新辅助化疗和化疗周期数。Kaplan-Meier 生存曲线显示，对化疗有反应的患者和接受最佳肿瘤减灭术的患者的生存均得到改善（p<0.001）。我们还表明，在无反应者和有反应者中，接受最佳肿瘤减灭术的患者的生存均得到改善（p<0.001）。
我们的分析表明，无论患者对化疗的反应如何，接受最佳肿瘤减灭术的患者均有总体生存获益。因此，如果可以达到最佳结果，即使对于晚期疾病患者，也应考虑进行肿瘤减灭术。本研究因缺乏评估接受新辅助化疗患者的能力而无法单独评估该亚组患者，但在总体分析中控制了治疗顺序。
