Kofoed Nina Groes, Falconer Henrik, Vanky Hanna, Johansson Hemming, Abraham-Nordling Mirna, Salehi Sahar
Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, and Department of Pelvic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden.
Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, and Department of Pelvic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden.
Gynecol Oncol. 2023 Mar;170:259-265. doi: 10.1016/j.ygyno.2023.01.030. Epub 2023 Feb 2.
Our objective was to examine oncologic outcome in women with advanced epithelial ovarian cancer (aEOC) receiving an intestinal stoma (IS) at the time of cytoreductive surgery (CRS), probability of stoma reversal (SR) and variables affecting odds of SR.
This population-based cohort study included all women diagnosed with aEOC between 2009 and 2018 in the Stockholm/Gotland Region of Sweden. The association between IS formation at CRS and survival was analyzed with proportional hazards regression yielding hazard ratios (HR) with 95% confidence intervals (CI), adjusted for predefined confounders. Cumulative incidence functions, with death or recurrence as competing risk, were used to estimate chance of SR. The association between clinical factors and SR was analyzed with logistic regression yielding odds ratios (OR) with 95% CI.
The final analysis included 888 women undergoing CRS for aEOC. Of these, 129 (14,5%) received an IS of which 74% (n = 95) were defunctioning and 26% (n = 34) permanent. IS was associated with an increased hazard of death (HR 1.30, CI 95%, 1.05-1.61; p = 0.02) in the univariate analysis, however not in the adjusted analysis. The probability of SR of defunctioning IS within 2 years was 48% (95% CI, 38-58). Median time to SR was 10 months. High surgical complexity score (SCS) was associated with increased odds of reversal (OR 3.43, 95% CI, 1.06-11.05; p = 0.04).
IS formation does not seem to affect prognosis in women with aEOC. We could not identify any factor, known at time of CRS, that may predict the odds of SR except a high SCS.
我们的目的是研究晚期上皮性卵巢癌（aEOC）患者在减瘤手术（CRS）时接受肠造口术（IS）后的肿瘤学结局、造口还纳（SR）的概率以及影响SR几率的变量。
这项基于人群的队列研究纳入了2009年至2018年期间在瑞典斯德哥尔摩/哥特兰地区被诊断为aEOC的所有女性。采用比例风险回归分析CRS时IS形成与生存之间的关联，得出风险比（HR）及95%置信区间（CI），并对预先定义的混杂因素进行校正。以死亡或复发作为竞争风险，使用累积发病率函数来估计SR的可能性。采用逻辑回归分析临床因素与SR之间的关联，得出优势比（OR）及95%CI。
最终分析纳入了888例因aEOC接受CRS的女性。其中，129例（14.5%）接受了IS，其中74%（n = 95）为非功能性造口，26%（n = 34）为永久性造口。单因素分析中，IS与死亡风险增加相关（HR 1.30，95%CI，1.05 - 1.61；p = 0.02），但在多因素分析中并非如此。非功能性IS在2年内还纳的概率为48%（95%CI，38 - 58）。SR的中位时间为10个月。高手术复杂性评分（SCS）与还纳几率增加相关（OR 3.43，95%CI，1.06 - 11.05；p = 0.04）。
IS形成似乎不影响aEOC女性的预后。除了高SCS外，我们未能识别出CRS时已知的任何可预测SR几率的因素。
