膈上淋巴结清扫术对伴有胸段淋巴结转移的IVB期卵巢癌患者生存的影响。
Impact of supradiaphragmatic lymphadenectomy on the survival of patients in stage IVB ovarian cancer with thoracic lymph node metastasis.
作者信息
Park Soo Jin, Na Kwon Joong, Lee Maria, Park In Kyu, Chung Hyun Hoon, Kang Chang Hyun, Kim Jae-Weon, Park Noh Hyun, Kim Young-Tae, Song Yong Sang, Park Samina, Kim Hee Seung
机构信息
Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
出版信息
Front Oncol. 2023 Aug 10;13:1203127. doi: 10.3389/fonc.2023.1203127. eCollection 2023.
INTRODUCTION
To evaluate the survival impact of supradiaphragmatic lymphadenectomy as part of debulking surgery in stage IVB ovarian cancer with thoracic lymph node metastasis (LNM).
METHODS
We retrospectively enrolled patients diagnosed with stage IVB ovarian, fallopian or primary peritoneal cancer between 2010 and 2020, carrying cardiophrenic, parasternal, anterior mediastinal or supraclavicular lymph nodes ≥5 mm on axial chest computed tomography. All tumors were classified into the abdominal (abdominal tumors and cardiophrenic lymph nodes) and supradiaphragmatic (parasternal, anterior mediastinal or supraclavicular lymph nodes) categories depending on the area involved. Residual tumors were classified into <5 vs ≥5 mm in the abdominal and supradiaphragmatic areas. Based on the site of recurrence, they were divided into abdominal, supradiaphragmatic and other areas.
RESULTS
A total of 120 patients underwent primary debulking surgery (PDS, n=68) and interval debulking surgery after neoadjuvant chemotherapy (IDS/NAC, n=53). Residual tumors in the supradiaphragmatic area ≥5 mm adversely affected progression-free survival (PFS) and overall survival (OS) with marginal significance after PDS despite the lack of effect on survival after IDS/NAC (adjusted hazard ratios [HRs], 6.478 and 6.370; 95% confidence intervals [CIs], 2.224-18.864 and 0.953-42.598). Further, the size of residual tumors in the abdominal area measuring ≥5 mm diminished OS after IDS/NAC (adjusted HR, 9.330; 95% CIs, 1.386-62.800).
CONCLUSION
Supradiaphragmatic lymphadenectomy during PDS may improve survival in patients diagnosed with stage IVB ovarian cancer manifesting thoracic LNM. Further, suboptimal debulking surgery in the abdominal area may be associated with poor OS after IDS/NAC.
TRIAL REGISTRATION
ClinicalTrials.gov (NCT05005650; https://clinicaltrials.gov/ct2/show/NCT05005650; first registration, 13/08/2021).Research Registry (Research Registry UIN, researchregistry7366; https://www.researchregistry.com/browse-the-registry#home/?view_2_search=researchregistry7366&view_2_page=1).
引言
评估膈上淋巴结清扫术作为伴有胸段淋巴结转移（LNM）的IVB期卵巢癌肿瘤细胞减灭术一部分对生存的影响。
方法
我们回顾性纳入了2010年至2020年间被诊断为IVB期卵巢、输卵管或原发性腹膜癌的患者，其胸部轴向计算机断层扫描显示心膈角、胸骨旁、前纵隔或锁骨上淋巴结≥5mm。根据受累区域，所有肿瘤被分为腹部（腹部肿瘤和心膈角淋巴结）和膈上（胸骨旁、前纵隔或锁骨上淋巴结）两类。腹部和膈上区域的残留肿瘤按<5mm与≥5mm进行分类。根据复发部位，将其分为腹部、膈上和其他区域。
结果
共有120例患者接受了初次肿瘤细胞减灭术（PDS，n = 68）和新辅助化疗后的间隔肿瘤细胞减灭术（IDS/NAC，n = 53）。膈上区域残留肿瘤≥5mm对PDS后的无进展生存期（PFS）和总生存期（OS）有不利影响，具有边缘统计学意义，尽管对IDS/NAC后的生存无影响（调整后风险比[HRs]分别为6.478和6.370；95%置信区间[CIs]分别为2.224 - 18.864和0.953 - 42.598）。此外，腹部区域残留肿瘤≥5mm的大小在IDS/NAC后降低了OS（调整后HR，9.330；95% CIs，1.386 - 62.800）。
结论
PDS期间进行膈上淋巴结清扫术可能改善诊断为伴有胸段LNM的IVB期卵巢癌患者的生存。此外，腹部区域减瘤不充分的手术可能与IDS/NAC后的不良OS相关。
试验注册
ClinicalTrials.gov（NCT05005650；https://clinicaltrials.gov/ct2/show/NCT05005650；首次注册，2021年8月13日）。研究注册库（研究注册库UIN，researchregistry7366；https://www.researchregistry.com/browse-the-registry#home/?view_2_search=researchregistry7366&view_2_page=1）。
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