原发性细胞减灭术与新辅助化疗治疗突变型晚期高级别浆液性卵巢癌患者的 10 年生存分析。
Primary cytoreductive surgery compared with neoadjuvant chemotherapy in patients with mutated advanced high grade serous ovarian cancer: 10 year survival analysis.
机构信息
Division of Gynaecologic Oncology, Princess Margaret Cancer Centre/University Health Network/Sinai Health Systems, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada.
University of Toronto, Toronto, Ontario, Canada.
出版信息
Int J Gynecol Cancer. 2024 Jun 3;34(6):879-885. doi: 10.1136/ijgc-2023-005065.
OBJECTIVES
Given the high response to platinum based chemotherapy in 1/2 mutated high grade serous ovarian cancers, there is uncertainty about the relative benefits of primary cytoreductive surgery versus neoadjuvant chemotherapy in this population. We aimed to compare the survival outcomes for women with 1/2 mutated high grade serous ovarian cancers undergoing either primary cytoreductive surgery or neoadjuvant chemotherapy.
METHODS
We conducted a retrospective cohort study of all stage III/IV mutated high grade serous ovarian cancers treated with primary cytoreductive surgery or neoadjuvant chemotherapy at a single tertiary cancer center between 1991 and 2020. Baseline demographics, initial disease burden, surgical complexity, and survival outcomes were examined.
RESULTS
Of 314 women with germline or somatic mutations, 194 (62%) underwent primary cytoreductive surgery and 120 (38%) underwent neoadjuvant chemotherapy followed by interval cytoreductive surgery. Those undergoing primary cytoreductive surgery were younger (median age 53 years (range 47-59) vs 59 years (50-65), p<0.001), but there were no differences in functional status or underlying comorbidities. The initial disease burden was lower (disease score high (40% vs 44%; p<0.001) but surgical complexity was higher (surgical complexity score high (18% vs 3%; p<0.001) in the primary cytoreductive surgery cohort. The rate of optimal or complete cytoreduction was similar in both groups (89% vs 90%; p=0.23) as well as the rate of poly (ADP-ribose) polymerase inhibitor use (62% vs 68%; p=0.3). The 10 year overall survival and recurrence free survival were superior in the primary cytoreductive surgery cohort (overall survival 49% vs 25%, p<0.001 and progression free survival 25% vs 10%, p<0.001). After controlling for confounders, primary cytoreductive surgery remained a significant predictor of improved overall survival (hazard ratio (HR) 0.45; 95% confidence interval (CI) 0.27 to 0.74; p=0.002) and recurrence free survival (HR 0.55; 95% CI 0.37 to 0.80; p=0.002).
CONCLUSIONS
Primary cytoreductive surgery was associated with improved survival in women with stage III/IV mutated high grade serous ovarian cancers compared with neoadjuvant chemotherapy.
目的
鉴于 1/2 种突变型高级别浆液性卵巢癌对铂类化疗的高反应，在该人群中，原发性细胞减灭术与新辅助化疗的相对益处尚不确定。我们旨在比较接受原发性细胞减灭术或新辅助化疗的 1/2 种突变型高级别浆液性卵巢癌患者的生存结局。
方法
我们对 1991 年至 2020 年间在一家三级癌症中心接受原发性细胞减灭术或新辅助化疗治疗的所有 III/IV 期突变型高级别浆液性卵巢癌患者进行了回顾性队列研究。检查了基线人口统计学、初始疾病负担、手术复杂性和生存结局。
结果
在 314 名具有种系或体细胞突变的女性中，194 名（62%）接受了原发性细胞减灭术，120 名（38%）接受了新辅助化疗后进行了间隔性细胞减灭术。接受原发性细胞减灭术的患者年龄较小（中位年龄 53 岁（范围 47-59）比 59 岁（50-65），p<0.001），但功能状态或潜在合并症无差异。初始疾病负担较低（疾病评分高（40%比 44%；p<0.001），但手术复杂性较高（手术复杂性评分高（18%比 3%；p<0.001）在原发性细胞减灭术组。两组的最佳或完全细胞减灭率相似（89%比 90%；p=0.23），以及聚（ADP-核糖）聚合酶抑制剂的使用率也相似（62%比 68%；p=0.3）。原发性细胞减灭术组的 10 年总生存率和无复发生存率均优于新辅助化疗组（总生存率 49%比 25%，p<0.001和无进展生存率 25%比 10%，p<0.001）。在控制混杂因素后，原发性细胞减灭术仍然是总生存率（风险比（HR）0.45；95%置信区间（CI）0.27 至 0.74；p=0.002）和无复发生存率（HR 0.55；95%CI 0.37 至 0.80；p=0.002）的显著预测因素。
结论
与新辅助化疗相比，原发性细胞减灭术与 III/IV 期 1/2 种突变型高级别浆液性卵巢癌患者的生存改善相关。
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