新辅助化疗后晚期卵巢癌的微创间隔减瘤术。
Minimally invasive interval debulking surgery for advanced ovarian cancer after neoadjuvant chemotherapy.
机构信息
Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States.
出版信息
Gynecol Oncol. 2023 May;172:130-137. doi: 10.1016/j.ygyno.2023.01.017. Epub 2023 Mar 26.
OBJECTIVE
Assess outcomes of interval debulking surgery (IDS) after neoadjuvant chemotherapy via minimally invasive surgery (MIS) compared with laparotomy in patients with advanced epithelial ovarian cancer.
METHODS
Patients diagnosed with stage IIIC or IV epithelial ovarian cancer between 2013 and 2018 who received neoadjuvant chemotherapy and IDS were identified in the National Cancer Database. Primary outcome was overall survival. Secondary outcomes were 5-year survival, 30- and 90-day postoperative mortality, extent of surgery, residual disease, hospitalization duration, surgical conversions, and unplanned readmissions. Propensity score matching was used to compare MIS and laparotomy for IDS. Association of treatment approach with overall survival was assessed using Kaplan-Meier method and Cox regression. Sensitivity analysis was conducted for effect of unmeasured confounders.
RESULTS
A total of 7897 patients met inclusion criteria; 2021 (25.6%) underwent MIS. Percentage undergoing MIS increased from 20.3%-29.0% over the study period. After propensity score matching, median overall survival was 46.7 months in the MIS group versus 41.0 months in the laparotomy group [hazard ratio (HR) 0.86 (95%CI 0.79-0.94)]. Five-year survival probability was higher in MIS versus laparotomy (38.3% vs 34.8%, p < 0.01). There was lower 30- and 90-day mortality (0.3% vs 0.7% [p = 0.04] and 1.4% vs 2.5% [p = 0.01], respectively), shorter length of stay (median 3 vs 5 days, p < 0.01), lower residual disease (23.9% vs 26.7%, p < 0.01), and lower additional cytoreductive procedures (59.3% vs 70.8%, p < 0.01) in MIS compared to laparotomy, with similar rates of unplanned readmission (2.7% vs 3.1%, p = 0.39).
CONCLUSIONS
Patients who undergo IDS by MIS have similar overall survival and decreased morbidity compared with laparotomy.
目的
评估新辅助化疗后通过微创外科（MIS）进行间隔减瘤手术（IDS）与剖腹手术治疗晚期上皮性卵巢癌患者的结局。
方法
在国家癌症数据库中，确定了 2013 年至 2018 年间接受新辅助化疗和 IDS 的 IIIC 期或 IV 期上皮性卵巢癌患者。主要结局为总生存率。次要结局包括 5 年生存率、30 天和 90 天术后死亡率、手术范围、残留疾病、住院时间、手术转换和计划外再入院。采用倾向评分匹配比较 MIS 和剖腹手术的 IDS。采用 Kaplan-Meier 法和 Cox 回归评估治疗方法与总生存率的关系。进行敏感性分析以评估未测量混杂因素的影响。
结果
共有 7897 例患者符合纳入标准；2021 例（25.6%）接受了 MIS。在研究期间，接受 MIS 的比例从 20.3%增加到 29.0%。在倾向评分匹配后，MIS 组的中位总生存率为 46.7 个月，剖腹手术组为 41.0 个月[风险比（HR）0.86（95%CI 0.79-0.94)]。MIS 组的 5 年生存率高于剖腹手术组（38.3%比 34.8%，p < 0.01）。MIS 组的 30 天和 90 天死亡率较低（分别为 0.3%比 0.7%[p = 0.04]和 1.4%比 2.5%[p = 0.01]），住院时间较短（中位数 3 天比 5 天，p < 0.01），残留疾病较少（23.9%比 26.7%，p < 0.01），需要进一步减瘤的手术较少（59.3%比 70.8%，p < 0.01），计划外再入院率相似（2.7%比 3.1%，p = 0.39）。
结论
与剖腹手术相比，接受 MIS 进行 IDS 的患者具有相似的总生存率和较低的发病率。
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