Romero Violeta, Angeles Martina Aida, Rodríguez González Elena, Cabarrou Bastien, Gil-Moreno Antonio, Pérez-Benavente Asunción, Spagnolo Emanuela, Guyon Frédéric, Babin Guillaume, Bebia Vicente, Luzarraga Aznar Ana, Bataillon Guillaume, Bétrian Sarah, Ferron Gwénaël, Hernández Alicia, Martinez Alejandra
Gynecological Oncology Unit, La Paz Investigation Institute (IdiPAZ), La Paz University Hospital, Madrid, Spain.
Gynecological Oncology Unit, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
Int J Gynecol Cancer. 2025 Jan 6. doi: 10.1136/ijgc-2024-005692.
The aim of this study was to compare surgical complexity, post-operative complications, and survival outcomes between patients with minimal residual disease (completeness of cytoreduction (CC) score) CC-1 at the time of primary debulking surgery and those with complete cytoreduction (CC-0) at the time of interval debulking surgery.
A retrospective multicenter study was conducted of patients with advanced ovarian cancer (International Federation of Gynecology and Obstetrics stage IIIC-IV) who underwent cytoreductive surgery achieving either minimal or no residual disease between January 2008 and December 2015. Patients underwent either primary or interval debulking surgery after receiving ≥3 cycles of neoadjuvant chemotherapy. The sub-group of patients with primary debulking surgery/CC-1 was compared with those with interval debulking surgery/CC-0. Overall survival and disease-free survival were estimated using the Kaplan-Meier method.
A total of 549 patients were included, with upfront surgery performed in 175 patients (31.9%) and 374 patients (68.1%) undergoing interval debulking surgery. After primary debulking surgery, 157/175 (89.7%) had complete cytoreduction and 18/175 (10.3%) had minimal residual disease (primary debulking surgery/CC-1 group), while after interval debulking surgery, 324/374 (86.6%) had complete cytoreduction (interval debulking surgery/CC-0 group) and 50/374 (13.4%) had minimal residual disease. The rate of patients with peritoneal cancer index >10 was 14/17 (82.4%) for the primary debulking surgery/CC-1 group and 129/322 (40.1%) for the interval debulking surgery/CC-0 (p<0.001). The rate of patients with an Aletti score of ≥8 was 11/18 (61.1%) and 132/324 (40.7%), respectively (p=0.09) and the rate of major post-operative complications was 5/18 (27.8%) and 64/324 (19.8%), respectively (p=0.38). Overall median disease-free and overall survival were 19.4 months (95% CI 18.0 to 20.6) and 56.7 months (95%CI 50.2 to 65.8), respectively. Median disease-free survival for the primary debulking surgery/CC-1 group was 16.7 months (95% CI 13.6 to 20.0) versus 18.2 months (95% CI 16.4 to 20.0) for the interval debulking surgery/CC-0 group (p=0.56). Median overall survival for the primary debulking surgery/CC-1 group was 44.7 months (95% CI 34.3 to not reached) and 49.4 months (95% CI 46.2 to 57.3) for the interval debulking surgery/CC-0 group (p=0.97).
Patients with primary debulking surgery with minimal residual disease and those with interval debulking surgery with no residual disease had similar survival outcomes. Interval surgery should be considered when achieving absence of residual disease is challenging at upfront surgery, given the lower tumor burden found during surgery.
本研究旨在比较初次肿瘤细胞减灭术时残留疾病极少（细胞减灭术完成度（CC）评分CC-1）的患者与中间性肿瘤细胞减灭术时达到完全细胞减灭（CC-0）的患者之间的手术复杂性、术后并发症及生存结局。
对2008年1月至2015年12月期间接受肿瘤细胞减灭术且残留疾病极少或无残留疾病的晚期卵巢癌患者（国际妇产科联盟分期IIIC-IV期）进行一项回顾性多中心研究。患者在接受≥3个周期新辅助化疗后接受初次或中间性肿瘤细胞减灭术。将初次肿瘤细胞减灭术/CC-1的患者亚组与中间性肿瘤细胞减灭术/CC-0的患者进行比较。采用Kaplan-Meier法估计总生存期和无病生存期。
共纳入549例患者，175例（31.9%）接受 upfront手术，374例（68.1%）接受中间性肿瘤细胞减灭术。初次肿瘤细胞减灭术后，157/175例（89.7%）实现了完全细胞减灭，18/175例（10.3%）残留疾病极少（初次肿瘤细胞减灭术/CC-1组）；而中间性肿瘤细胞减灭术后，324/374例（86.6%）实现了完全细胞减灭（中间性肿瘤细胞减灭术/CC-0组），50/374例（13.4%）残留疾病极少。初次肿瘤细胞减灭术/CC-1组腹膜癌指数>10的患者比例为14/17（82.4%），中间性肿瘤细胞减灭术/CC-0组为129/322（40.1%）（p<0.001）。Aletti评分≥8的患者比例分别为11/18（61.1%）和132/324（40.7%）（p=0.09），主要术后并发症发生率分别为5/18（27.8%）和64/324（19.8%）（p=0.38）。总的无病生存期和总生存期的中位数分别为19.4个月（95%CI 18.0至20.6）和56.7个月（95%CI 50.2至65.8）。初次肿瘤细胞减灭术/CC-1组的无病生存期中位数为16.7个月（95%CI 13.6至20.0），中间性肿瘤细胞减灭术/CC-0组为18.2个月（95%CI 16.4至20.0）（p=0.56）。初次肿瘤细胞减灭术/CC-1组的总生存期中位数为44.7个月（95%CI 34.3至未达到），中间性肿瘤细胞减灭术/CC-0组为49.4个月（95%CI 46.2至57.3）（p=0.97）。
初次肿瘤细胞减灭术残留疾病极少的患者与中间性肿瘤细胞减灭术无残留疾病的患者生存结局相似。鉴于初次手术时实现无残留疾病具有挑战性，而中间性手术时发现的肿瘤负荷较低，因此在初次手术难以实现无残留疾病时应考虑中间性手术。
