辅助化疗对初次细胞减灭术后晚期低级别浆液性卵巢癌患者总生存期的影响。

Impact of adjuvant chemotherapy on the overall survival of patients with advanced-stage low-grade serous ovarian carcinoma following primary cytoreductive surgery.

机构信息

Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA

Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

出版信息

Int J Gynecol Cancer. 2023 Dec 4;33(12):1906-1912. doi: 10.1136/ijgc-2023-004745.

DOI:10.1136/ijgc-2023-004745

PMID:37879909

Abstract

OBJECTIVE

To investigate the use and outcomes of adjuvant chemotherapy for patients with advanced-stage low-grade serous ovarian carcinoma following primary cytoreductive surgery.

METHODS

Patients diagnosed between 2010 and 2015 with International Federation of Gynecology and Obstetrics stage II-IV low-grade serous ovarian carcinoma who underwent primary debulking surgery with known residual disease status and had at least 1 month of follow-up were identified in the National Cancer Database. Adjuvant chemotherapy was defined as receipt of chemotherapy within 6 months of surgery. Overall survival was evaluated using the Kaplan-Meier method and compared with the log-rank test. A Cox model was constructed to control for a priori-selected confounders. A systematic review of the literature was also performed.

RESULTS

In total, 618 patients with stage II-IV low-grade serous ovarian carcinoma who underwent primary cytoreductive surgery were identified; 501 (81.1%) patients received adjuvant chemotherapy, while 117 (18.9%) patients did not. The median follow-up of the present cohort was 47.97 months. There was no difference in overall survival between patients who did and did not receive adjuvant chemotherapy (p=0.78; 4-year overall survival rates were 77.5% and 76.1%, respectively). After controlling for patient age, medical co-morbidities, disease stage, and residual disease status, administration of adjuvant chemotherapy was not associated with better overall survival (HR=0.87, 95% CI 0.55 to 1.38). Based on data from three retrospective studies, omission of adjuvant chemotherapy following cytoreductive surgery was not associated with worse progression-free survival benefit (HR=1.25, 95% CI 0.80 to 1.95) for patients with stage III-V low-grade serous ovarian carcinoma.

CONCLUSIONS

Adjuvant chemotherapy may not be associated with an overall survival benefit for patients with advanced-stage low-grade serous ovarian carcinoma following primary cytoreductive surgery.

摘要

目的

探讨在初次细胞减灭术后，高级别浆液性卵巢癌患者接受辅助化疗的应用和结果。

方法

本研究在美国国家癌症数据库中，选取了 2010 年至 2015 年间被诊断为国际妇产科联合会（FIGO）Ⅱ-Ⅳ期高级别浆液性卵巢癌、接受初次肿瘤细胞减灭术且已知残留疾病状态、并至少有 1 个月随访的患者。辅助化疗定义为术后 6 个月内接受化疗。使用 Kaplan-Meier 方法评估总生存期，并采用对数秩检验进行比较。构建 Cox 模型以控制预先选择的混杂因素。还进行了文献系统评价。

结果

共纳入 618 例接受初次细胞减灭术的Ⅱ-Ⅳ期高级别浆液性卵巢癌患者；501 例（81.1%）患者接受了辅助化疗，117 例（18.9%）患者未接受辅助化疗。本队列的中位随访时间为 47.97 个月。接受与未接受辅助化疗的患者之间的总生存期无差异（p=0.78；4 年总生存率分别为 77.5%和 76.1%）。在控制患者年龄、合并症、疾病分期和残留疾病状态后，辅助化疗的应用与更好的总生存期无关（HR=0.87，95%CI 0.55 至 1.38）。基于三项回顾性研究的数据，细胞减灭术后省略辅助化疗与 III 期至 V 期高级别浆液性卵巢癌患者的无进展生存期获益无差异（HR=1.25，95%CI 0.80 至 1.95）。