Mercy Medical Center, The Institute for Cancer Care, Department of Surgical Oncology, 227 St. Paul Place, Weinberg Building, 4th Floor, Baltimore, MD, 21202-2001, USA.
Mercy Medical Center, The Institute for Cancer Care, Department of Surgical Oncology, 227 St. Paul Place, Weinberg Building, 4th Floor, Baltimore, MD, 21202-2001, USA.
Eur J Surg Oncol. 2023 Aug;49(8):1495-1503. doi: 10.1016/j.ejso.2023.03.230. Epub 2023 Mar 30.
Ovarian carcinosarcoma (OCS) is an uncommon and aggressive malignancy, with poor response to current treatment approaches and no clear guidelines. Our aim is to evaluate the outcomes of an OCS cohort after cytoreduction with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC).
A descriptive cohort study was performed. Patients who underwent CRS/HIPEC for peritoneal dissemination from tubo-ovarian malignancies (1999-2021) were retrospectively reviewed. Patients with confirmed histopathologic diagnosis of FIGO stage III/IV OCS were included. Overall (OS) and progression-free survival (PFS) were determined with the Kaplan-Meier method.
Of 267 patients with tubo-ovarian malignancies reviewed, 7.5% (20/267) had OCS. Of these, 16 underwent CRS/HIPEC, including 9 for a new diagnosis and 7 for disease recurrence. Median age at surgery was 66.5 (IQR: 54.5-74.5) years. Nine (56.2%) patients were FIGO stage IV. Median peritoneal cancer index was 22 (IQR: 14-28). Complete cytoreduction was achieved in 15/16 (93.7%) cases. HIPEC agents included carboplatin (n = 7), cisplatin+doxorubicin (n = 4), and melphalan (n = 5). Major complications occurred in 4/16 (25%), with no 90-day mortality. Median follow-up was 41.8 months. Median PFS was 11.7 (95%CI: 10.5-17.1) months. Malignant bowel obstruction occurred in 3/16 (18.7%). Median OS from CRS/HIPEC was 21.3 (95%CI: 16.3-31.6) months, not reached for newly diagnosed vs 19.7 months for recurrent patients (p = 0.23).
CRS/HIPEC showed promising survival and abdominal disease control with low rates of malignant obstruction in patients with advanced stage OCS. Collaborative studies with larger cohorts and longer follow-up may further elucidate the role of CRS/HIPEC in OCS.
卵巢癌肉瘤（OCS）是一种罕见且侵袭性强的恶性肿瘤，对当前的治疗方法反应不佳，也没有明确的治疗指南。我们旨在评估接受细胞减灭术联合腹腔热灌注化疗（CRS/HIPEC）治疗的 OCS 患者的预后。
本研究为描述性队列研究。回顾性分析了 1999 年至 2021 年间因卵巢输卵管恶性肿瘤行 CRS/HIPEC 治疗的腹腔播散患者。纳入经组织病理学检查证实为国际妇产科联盟（FIGO）分期 III/IV 期 OCS 的患者。采用 Kaplan-Meier 法计算总生存期（OS）和无进展生存期（PFS）。
在 267 例卵巢输卵管恶性肿瘤患者中，OCS 占 7.5%（20/267）。其中 16 例行 CRS/HIPEC，包括新诊断 9 例，复发 7 例。手术时的中位年龄为 66.5（IQR：54.5-74.5）岁。9 例（56.2%）患者为 FIGO 分期 IV 期。中位腹膜癌指数为 22（IQR：14-28）。16 例患者中，15 例（93.7%）达到完全肿瘤细胞减灭术。HIPEC 药物包括卡铂（n=7）、顺铂+多柔比星（n=4）和美法仑（n=5）。4 例（25%）患者发生主要并发症，无 90 天内死亡。中位随访时间为 41.8 个月。中位 PFS 为 11.7（95%CI：10.5-17.1）个月。3 例（18.7%）患者发生恶性肠梗阻。CRS/HIPEC 后中位 OS 为 21.3（95%CI：16.3-31.6）个月，新诊断患者未达到，复发患者为 19.7 个月（p=0.23）。
对于晚期 OCS 患者，CRS/HIPEC 显示出良好的生存和腹部疾病控制效果，恶性梗阻发生率较低。开展更大规模队列和更长随访时间的协作研究，可能进一步阐明 CRS/HIPEC 在 OCS 中的作用。
