Gynaecological Oncology Unit, 2nd Academic Department of Obstetrics and Gynaecology, Aretaieion Hospital, 68989The National and Kapodistrian University of Athens, Athens, Greece.
Department of Surgical Oncology, Peritoneal Surface Malignancy Program, 376520Metropolitan Hospital, Athens, Greece.
Cancer Control. 2023 Jan-Dec;30:10732748231165878. doi: 10.1177/10732748231165878.
To identify prognostic factors of survival and recurrence in advanced ovarian cancer patients undergoing radical surgery and HIPEC.
In a single Department of Surgical Oncology, Peritoneal Surface Malignancy Program, and over a 16-year period, from a total of 274 epithelial ovarian cancer patients, retrospectively, we identified 152 patients undergoing complete (CC-0) or near-complete (CC-1) cytoreduction, including at least one colonic resection, and HIPEC.
Mean age of patients was 58.8 years and CC-0 was possible in 72.4%. Rates of in-hospital mortality and major morbidity were 2.6% and 15.7%. Only 122 (80.3%) patients completed Adjuvant Systemic Chemotherapy (ASCH). Rates of metastatic Total Lymph Nodes (TLN), Para-Aortic and Pelvic Lymph Nodes (PAPLN) and Large Bowel Lymph Nodes (LBLN) were 58.7%, 58.5%, and 51.3%, respectively. Median, 5- and 10-year survival rates were 39 months, 43%, and 36.2%, respectively. The recurrence rate was 35.5%. On univariate analysis, CC-1, high Peritoneal Cancer Index (PCI), in-hospital morbidity, and no adjuvant chemotherapy were adverse factors for survival and recurrence. On multivariate analysis, negative survival indicators were the advanced age of patients, extensive peritoneal dissemination, low total number of TLN and no systemic PAPLN. Metastatic LBLN and segmental resection of the small bowel (SIR) were associated with a high risk for recurrence.
CC-O is feasible in most advanced ovarian cancer patients and HIPEC may confer a survival benefit. Radical bowel resection, with its entire mesocolon, may be necessary, as its lymph nodes often harbor metastases influencing disease recurrence and survival. The role of metastatic bowel lymph nodes has to be taken into account when assessing the impact of systemic lymphadenectomy in this group of patients.
确定接受根治性手术和 HIPEC 的晚期卵巢癌患者的生存和复发的预后因素。
在一个外科肿瘤学系、腹膜表面恶性肿瘤计划中，在 16 年的时间里，从总共 274 名上皮性卵巢癌患者中，我们回顾性地确定了 152 名接受完全（CC-0）或接近完全（CC-1）减瘤术的患者，包括至少一次结肠切除术和 HIPEC。
患者的平均年龄为 58.8 岁，CC-0 可能为 72.4%。住院死亡率和主要发病率分别为 2.6%和 15.7%。只有 122 名（80.3%）患者完成了辅助全身化疗（ASCH）。转移性总淋巴结（TLN）、主动脉旁和骨盆淋巴结（PAPLN）和大肠道淋巴结（LBLN）的比率分别为 58.7%、58.5%和 51.3%。中位数、5 年和 10 年生存率分别为 39 个月、43%和 36.2%。复发率为 35.5%。在单因素分析中，CC-1、高腹膜癌指数（PCI）、住院期间发病率和无辅助化疗是生存和复发的不利因素。在多因素分析中，不利的生存指标是患者年龄较大、广泛的腹膜扩散、TLN 总数低且无全身 PAPLN。转移性 LBLN 和小肠节段切除术（SIR）与高复发风险相关。
CC-O 在大多数晚期卵巢癌患者中是可行的，HIPEC 可能带来生存获益。根治性结肠切除术及其整个结肠系膜可能是必要的，因为其淋巴结常存在转移，影响疾病的复发和生存。在评估这组患者的全身淋巴结清扫术的影响时，必须考虑转移性肠道淋巴结的作用。
