Heublein Sabine, Baum Joanna, Jaeger Anna, Grimm-Glang Donata, Olthoff Julia, Braicu Elena Ioana, Azzam Nieto Osama, Hassdenteufel Kathrin, Schmalfeldt Barbara, Hanker Lars, Wallwiener Markus, Schneeweiss Andreas, Sehouli Jalid, Pietzner Klaus
Department of Gynecology and Obstetrics, University of Heidelberg, 69120 Heidelberg, Germany.
National Center for Tumor Diseases, University Hospital and German Cancer Research Center Heidelberg, 69120 Heidelberg, Germany.
Cancers (Basel). 2023 Mar 29;15(7):2038. doi: 10.3390/cancers15072038.
Surgery is the backbone of early-stage ovarian cancer (OC) management. However, in practice, there is disagreement about the extent of surgical staging and whether additional adjuvant treatment should be provided. As omitting relevant diagnostic or therapeutic procedures might lead to undertreatment, we aimed to structurally investigate treatment practice in addition to prognostic factors in a multicentre series of patients (pts) diagnosed with early-stage OC.
Within this retrospective, multicentre study, medical records of 379 pts who had undergone surgery for suspected early-stage OC between January 2014 and March 2020 were analysed.
Of the 379 patients, 292 had pT stage 1a-2a and had complete data on the extent of surgical staging. At least one surgical step was omitted in 100 pts (34.2%). Complete surgical staging ( = 192; (65.8%)) was more often performed in high-grade serous OC and was independent of the healthcare level of the hospital where the initial diagnosis was made. Missing to take peritoneal biopsies was associated with reduced relapse-free-survival in incompletely staged, pT1 cases ( = 0.03). About every second patient (46.7%) with a final stage lower than FIGO IIB and treated with adjuvant chemotherapy received combination chemotherapy. and testing was only performed in a subset of pts, and mutations were detected in 18% (14/79) and 9% (7/85) pts, respectively.
This study helps to increase our understanding of early-stage OC treatment and prognosis. In addition to treating patients in compliance with current guidelines, the need for testing should also be considered for early-stage OC.
手术是早期卵巢癌（OC）治疗的核心。然而，在实际操作中，对于手术分期的范围以及是否应提供额外的辅助治疗存在分歧。由于遗漏相关诊断或治疗程序可能导致治疗不足，我们旨在对多中心系列诊断为早期OC的患者进行结构调查，研究治疗实践及预后因素。
在这项回顾性多中心研究中，分析了2014年1月至2020年3月期间因疑似早期OC接受手术的379例患者的病历。
379例患者中，292例为pT1a - 2a期，且有关于手术分期范围的完整数据。100例患者（34.2%）至少遗漏了一个手术步骤。完整的手术分期（n = 192；65.8%）在高级别浆液性OC中更常进行，且与初始诊断所在医院的医疗水平无关。在不完全分期的pT1病例中，未进行腹膜活检与无复发生存率降低相关（P = 0.03）。最终分期低于国际妇产科联盟（FIGO）IIB期且接受辅助化疗的患者中，约每两名患者中有一名（46.7%）接受了联合化疗。BRCA1和BRCA2检测仅在部分患者中进行，分别在18%（14/79）和9%（7/85）的患者中检测到突变。
本研究有助于增进我们对早期OC治疗和预后的理解。除了按照现行指南治疗患者外，对于早期OC还应考虑进行BRCA检测。
