Istinye University, Faculty of Medicine, Department of General Surgery, Liv Ulus Hospital, Istanbul, Turkey.
General Surgery and Digestive Hospices, Civils de Lyon, Centre Hospitalier Lyon Sud, 69495, Pierre-Bénite, France.
Eur J Surg Oncol. 2023 Aug;49(8):1489-1494. doi: 10.1016/j.ejso.2023.03.214. Epub 2023 Apr 13.
The purpose of our study was to evaluate outcome data after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with peritoneal metastasis originating from advanced epithelial ovarian carcinoma (PMOC).
A retrospective international multi-institutional registry was established through collaborative efforts of participating units affiliated with the Peritoneal Surface Oncology Group.
One thousand four hundred and ninety-one patients from 11 specialized units underwent CRS and HIPEC that of those 326 (21.9%) upfront surgeries, 504 (33.8%) interval surgery, and 661(44.3%) recurrent cases. Complete Cytoreduction(CC0/1) was achieved in 1213 patients (81.3%). Treatment -related mortality was 0.8%, major operative complications (Grades 3-5) was 25.1%. Factors associated with major operative complications include prior surgical score (PSS for recurrent cases; RC) PSS>2,p = 0.000), PCI(≤15, >15 cut-off level; p ≤ 0.000), completeness of cytoreduction (CC, p=0.000), high CA125 levels (>25 mg/dl), presence of ascites, high CRP (>5 mg/dl) levels and low albumin levels (below to 2.5 mg/dl) (p ≤ 0.05). The median survival was 58 months in upfront surgery(UFS), 60 months in interval surgery(IS), and 42 months in RC. The overall survival for five years was 45% for UFS, 37% for IS, 28% for RC cases. CCscore (p = 0.000), CA125, CRP and albumin levels (p ≤ 0.05) were predictors for progression free survival. PCI(p ≤ 0.000), major postoperative complications (p = 0.004), incomplete CRS(CC2/3)(p < 0.001), prior chemotherapy (hazard ratio [HR], 3-8; p < 0.001) and PSS>2 for RC were independent predictors of poor overall survival.
The combined treatment strategy for PMOC may be performed safely with acceptable morbidity and mortality in the specialized units.
我们的研究目的是评估来源于晚期上皮性卵巢癌（PMOC）的腹膜转移患者接受细胞减灭术（CRS）和腹腔热灌注化疗（HIPEC）后的结果数据。
通过参与腹膜表面肿瘤学组附属单位的合作努力，建立了一个回顾性国际多机构登记处。
来自 11 个专门单位的 1491 名患者接受了 CRS 和 HIPEC，其中 326 例（21.9%）为初始手术，504 例（33.8%）为间隔手术，661 例（44.3%）为复发病例。1213 例患者达到完全肿瘤减灭术（CC0/1）（81.3%）。治疗相关死亡率为 0.8%，主要手术并发症（3-5 级）为 25.1%。与主要手术并发症相关的因素包括既往手术评分（RC 的复发性病例 PSS）>2，p=0.000）、PCI（≤15，>15 截止水平；p≤0.000）、肿瘤细胞减灭术的完整性（CC，p=0.000）、高 CA125 水平（>25mg/dl）、腹水、高 C 反应蛋白（CRP）（>5mg/dl）和低白蛋白水平（<2.5mg/dl）（p≤0.05）。初始手术（UFS）的中位生存期为 58 个月，间隔手术（IS）为 60 个月，复发手术（RC）为 42 个月。UFS、IS 和 RC 病例的五年总生存率分别为 45%、37%和 28%。CC 评分（p=0.000）、CA125、CRP 和白蛋白水平（p≤0.05）是无进展生存期的预测因素。PCI（p≤0.000）、术后主要并发症（p=0.004）、不完全 CRS（CC2/3）（p<0.001）、既往化疗（风险比 [HR]，3-8；p<0.001）和 RC 时 PSS>2 是总生存不良的独立预测因素。
在专门单位，来源于晚期上皮性卵巢癌的腹膜转移患者接受细胞减灭术和腹腔热灌注化疗的联合治疗策略是安全的，发病率和死亡率可以接受。
