贝伐珠单抗联合二次细胞减灭术对铂类敏感复发性卵巢透明细胞癌生存结局的影响：一项来自韩国的多中心研究。
Impact of bevacizumab and secondary cytoreductive surgery on survival outcomes in platinum-sensitive relapsed ovarian clear cell carcinoma: A multicenter study in Korea.
机构信息
Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.
Center for Gynecologic Cancer, National Cancer Center, Goyang, Republic of Korea.
出版信息
Gynecol Oncol. 2022 Sep;166(3):444-452. doi: 10.1016/j.ygyno.2022.07.011. Epub 2022 Jul 19.
OBJECTIVE
This study investigated survival outcomes for platinum-sensitive relapsed ovarian clear cell carcinoma (OCCC) by treatment method.
METHODS
OCCC patients with platinum-sensitive recurrence that received secondary treatment at five institutions between July 2007 and June 2021 were included. Patient characteristics and survival outcomes were compared according to the use of bevacizumab (BEV) during second-line chemotherapy and secondary cytoreductive surgery (CRS).
RESULTS
138 patients were included. The BEV (n = 36) and non-BEV (n = 102) groups had similar initial FIGO stages and proportions of secondary CRS. The BEV group showed improved progression-free survival (PFS; median, 15.4 vs. 7.5 months; P = 0.042) and overall survival (OS; P = 0.043) compared to the non-BEV group. In multivariate analyses, BEV was identified as an independent prognostic factor for PFS (adjusted hazard ratio [aHR], 0.571; 95% confidence interval [CI], 0.354-0.921; P = 0.022) and OS (aHR, 0.435; 95%CI, 0.195-0.970; P = 0.042). The secondary CRS group (n = 42) had early-stage disease at diagnosis more frequently (P = 0.009) and multi-site metastasis (P < 0.001) at recurrence less frequently than the no surgery group (n = 96). The secondary CRS group showed significantly better PFS (median, 33.7 vs. 7.2 months; P < 0.001) and OS (P < 0.001). Secondary CRS was associated with a significantly improved PFS (aHR, 0.297; 95% CI, 0.183-0.481; P < 0.001) and OS (aHR, 0.276; 95% CI, 0.133-0.576; P = 0.001). The BEV and non-BEV groups showed similar PFS and OS among the patients who underwent secondary CRS. In contrast, the BEV group showed improved PFS and OS among patients who did not undergo surgery.
CONCLUSIONS
The use of BEV during second-line chemotherapy and secondary CRS may improve PFS and OS in patients with platinum-sensitive relapsed OCCC. Further prospective studies are warranted.
目的
本研究通过治疗方法探讨铂类敏感复发性卵巢透明细胞癌（OCCC）的生存结局。
方法
纳入 2007 年 7 月至 2021 年 6 月期间在五家机构接受二线治疗的铂类敏感复发的 OCCC 患者。根据二线化疗中贝伐珠单抗（BEV）的使用情况和二次细胞减灭术（CRS）比较患者特征和生存结局。
结果
共纳入 138 例患者。BEV（n=36）和非 BEV（n=102）组的初始 FIGO 分期和二次 CRS 的比例相似。与非 BEV 组相比，BEV 组的无进展生存期（PFS；中位，15.4 个月 vs. 7.5 个月；P=0.042）和总生存期（OS；P=0.043）均得到改善。多变量分析显示，BEV 是 PFS（调整后的危险比[aHR]，0.571；95%置信区间[CI]，0.354-0.921；P=0.022）和 OS（aHR，0.435；95%CI，0.195-0.970；P=0.042）的独立预后因素。二次 CRS 组（n=42）在诊断时更常表现为早期疾病（P=0.009），在复发时更不易出现多部位转移（P<0.001），而非手术组（n=96）。二次 CRS 组的 PFS（中位，33.7 个月 vs. 7.2 个月；P<0.001）和 OS（P<0.001）均显著改善。二次 CRS 与 PFS（aHR，0.297；95%CI，0.183-0.481；P<0.001）和 OS（aHR，0.276；95%CI，0.133-0.576；P=0.001）显著改善相关。在接受二次 CRS 的患者中，BEV 和非 BEV 组的 PFS 和 OS 相似。相反，在未接受手术的患者中，BEV 组的 PFS 和 OS 得到改善。
结论
二线化疗中使用 BEV 和二次 CRS 可能改善铂类敏感复发性 OCCC 患者的 PFS 和 OS。需要进一步的前瞻性研究。
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