From the Kelly Gynecologic Oncology Service, Johns Hopkins Medical Institutions, Baltimore, MD.
J Clin Oncol. 2023 Sep 1;41(25):4065-4076. doi: 10.1200/JCO.22.02765.
To evaluate the relative effect of percent maximal cytoreductive surgery and other prognostic variables on survival among cohorts of patients with advanced-stage ovarian carcinoma treated with platinum-based chemotherapy.
Eighty-one cohorts of patients with stage III or IV ovarian carcinoma (6,885 patients) were identified from articles in MEDLINE (1989 through 1998). Linear regression models, with weighted correlation calculations, were used to assess the effects on log median survival time of the proportion of each cohort undergoing maximal cytoreduction, dose-intensity of the platinum compound administered, proportion of patients with stage IV disease, median age, and year of publication.
There was a statistically significant positive correlation between percent maximal cytoreduction and log median survival time, and this correlation remained significant after controlling for all other variables ( < .001). Each 10% increase in maximal cytoreduction was associated with a 5.5% increase in median survival time. When actuarial survival was estimated, cohorts with ≤ 25% maximal cytoreduction had a mean weighted median survival time of 22.7 months, whereas cohorts with more than 75% maximal cytoreduction had a mean weighted median survival time of 33.9 months-an increase of 50%. The relationship between platinum dose-intensity and log median survival time was not statistically significant.
During the platinum era, maximal cytoreduction was one of the most powerful determinants of cohort survival among patients with stage III or IV ovarian carcinoma. Consistent referral of patients with apparent advanced ovarian cancer to expert centers for primary surgery may be the best means currently available for improving overall survival.
评估在接受铂类为基础的化疗的晚期卵巢癌患者队列中，最大程度减瘤术的百分比和其他预后变量对生存的相对影响。
从 MEDLINE（1989 年至 1998 年）的文章中确定了 81 个 III 期或 IV 期卵巢癌患者队列（6885 例患者）。使用线性回归模型和加权相关计算，评估每个队列接受最大程度减瘤术的比例、所给予的铂化合物的剂量强度、IV 期疾病患者的比例、中位年龄和发表年份对数均生存时间的影响。
最大程度减瘤术的百分比与对数均生存时间之间存在统计学上显著的正相关，并且在控制所有其他变量后，这种相关性仍然显著（<0.001）。最大程度减瘤术增加 10%与中位生存时间增加 5.5%相关。当估计生存的实际情况时，最大程度减瘤术比例≤25%的队列的加权中位生存时间为 22.7 个月，而最大程度减瘤术比例>75%的队列的加权中位生存时间为 33.9 个月-增加了 50%。铂类剂量强度与对数均生存时间之间的关系没有统计学意义。
在铂类时代，最大程度减瘤术是 III 期或 IV 期卵巢癌患者队列生存的最重要决定因素之一。将明显晚期卵巢癌患者持续转诊至专家中心进行初次手术可能是目前提高总体生存的最佳手段。
