Betrian Sarah, Angeles Martina Aida, Gil Moreno Antonio, Cabarrou Bastien, Deslandres Marion, Ferron Gwenael, Mery Eliane, Floquet Anne, Guyon Frederic, Pérez-Benavente Assumpció, Spagnolo Emanuela, Rychlik Agnieszka, Gladieff Laurence, Hernández Gutiérrez Alicia, Martinez Alejandra
Department of Medical Oncology, Institut Universitaire du Cancer de Toulouse, Toulouse, France
Surgical Oncology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France.
Int J Gynecol Cancer. 2022 Aug 1;32(8):967-974. doi: 10.1136/ijgc-2021-003313.
We sought to evaluate the impact of chemotherapy response score according to the number of cycles of neoadjuvant chemotherapy, on disease-free survival and overall survival, in patients with advanced epithelial ovarian cancer ineligible for primary debulking surgery.
This multicenter retrospective study included patients with International Federation of Gynecology and Obstetrics (FIGO) stage IIIC-IV epithelial ovarian cancer who underwent 3-4 or 6 cycles of a platinum and taxane-based neoadjuvant chemotherapy, followed by complete cytoreduction surgery (CC-0) or cytoreduction to minimal residual disease (CC-1), between January 2008 and December 2015, in four institutions. Disease-free survival and overall survival were assessed according to the histological response to chemotherapy defined by the validated chemotherapy response score.
A total of 365 patients were included: 219 (60.0%) received 3-4 cycles of neoadjuvant chemotherapy, and 146 (40.0%) had 6 cycles of neoadjuvant chemotherapy before cytoreductive surgery. There were no significant differences in early relapses, disease-free survival, and overall survival according to the number of neoadjuvant chemotherapy cycles. However, regardless of the number cycles of neoadjuvant chemotherapy, persistent extensive histological disease (chemotherapy response score 1-2) was significantly associated with a higher peritoneal cancer index, minimal residual disease (CC-1), and early relapses. Median disease-free survival in patients with complete or near-complete response (score 3) was 28.3 months (95% CI 21.6 to 36.8), whereas it was 16.3 months in patients with chemotherapy response score 1-2 (95% CI 14.7 to 18.0, p<0.001).
In our cohort, the number of neoadjuvant chemotherapy cycles was not associated with disease-free survival or overall survival. Chemotherapy response score 3 improved oncological outcome regardless of the number of neoadjuvant chemotherapy cycles.
我们试图评估在无法进行初次肿瘤细胞减灭术的晚期上皮性卵巢癌患者中，根据新辅助化疗周期数得出的化疗反应评分对无病生存期和总生存期的影响。
这项多中心回顾性研究纳入了国际妇产科联盟（FIGO）IIIC-IV期上皮性卵巢癌患者，这些患者于2008年1月至2015年12月期间在四家机构接受了3-4个周期或6个周期的铂类和紫杉类新辅助化疗，随后进行了完全肿瘤细胞减灭术（CC-0）或减瘤至微小残留病灶（CC-1）。根据经过验证的化疗反应评分所定义的化疗组织学反应评估无病生存期和总生存期。
共纳入365例患者：219例（60.0%）接受了3-4个周期的新辅助化疗，146例（40.0%）在肿瘤细胞减灭术前接受了6个周期的新辅助化疗。根据新辅助化疗周期数，早期复发、无病生存期和总生存期无显著差异。然而，无论新辅助化疗周期数多少，持续性广泛组织学疾病（化疗反应评分为1-2）与较高的腹膜癌指数、微小残留病灶（CC-1）和早期复发显著相关。完全或接近完全缓解（评分3）的患者中位无病生存期为28.3个月（95%CI 21.6至36.8），而化疗反应评分为1-2的患者为16.3个月（95%CI 14.7至18.0，p<0.001）。
在我们的队列中，新辅助化疗周期数与无病生存期或总生存期无关。无论新辅助化疗周期数多少，化疗反应评分3均可改善肿瘤学结局。
