Pietschmann Maximilian, Jaeger Anna, Reuter Susanne, Schmalfeldt Barbara
Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Geburtshilfe Frauenheilkd. 2024 Jul 4;84(9):866-875. doi: 10.1055/a-2331-0900. eCollection 2024 Sep.
Residual tumor after cytoreductive surgery is the most important prognostic parameter for the outcome of patients with advanced ovarian cancer (5-year survival rate FIGO III 39%, FIGO IV 20%). As more than half of the patients suffer from upper abdominal tumor burden, surgery in this area is inevitable in order to achieve adequate cytoreduction. Our analysis focuses on the impact of upper abdominal interventions (UAI) regarding residual tumor and prognosis (OS, PFS).
A total of n = 261 patients with advanced primary ovarian cancer stage FIGO III and IV and radical cytoreductive surgery at the Gynecologic Cancer Center Hamburg-Eppendorf between 2014 and 2019 were analyzed in a retrospective study design and divided into two groups: one with UAI (n = 160) and one without UAI (n = 101).
Patients with UAI showed significantly more often a residual tumor of less than 1 cm (R1) than patients without UAI and had a significantly longer OS (59 vs. 45 months [p = 0.041]). Deperitonealization of the diaphragm was the most common (144/160) and prognostically most relevant procedure for UAI. Especially the subgroup with FIGO IIIC stage seemed to benefit most from UAI. However, in multivariate analysis residual tumor burden was the strongest prognostic parameter for survival, followed by FIGO stage and UAI. Mortality was low within in the UAI group (0.6%).
UAI is an essential part of cytoreductive surgery in advanced ovarian cancer patients with tumor spread into the upper abdomen as it significantly prolongs survival. The procedure appears to be safe with low mortality. Achieving R1 rather than R2 due to radical surgery combined with UAI should be preferred compared to the early termination of the operation, as this has a significant impact on the prognosis of the patients.
减瘤手术后的残留肿瘤是晚期卵巢癌患者预后的最重要预测参数（国际妇产科联盟（FIGO）III期患者5年生存率为39%，FIGO IV期为20%）。由于超过一半的患者存在上腹部肿瘤负荷，为了实现充分减瘤，该区域的手术不可避免。我们的分析聚焦于上腹部干预（UAI）对残留肿瘤和预后（总生存期（OS）、无进展生存期（PFS））的影响。
在一项回顾性研究设计中，分析了2014年至2019年间在汉堡-埃彭多夫妇科癌症中心接受根治性减瘤手术的n = 261例FIGO III期和IV期原发性晚期卵巢癌患者，并将其分为两组：一组接受UAI（n = 160），另一组未接受UAI（n = 101）。
与未接受UAI的患者相比，接受UAI的患者更常出现小于1 cm的残留肿瘤（R1），且OS显著更长（59个月对45个月[p = 0.041]）。膈肌去腹膜化是UAI最常见的（144/160）且预后最相关的手术。特别是FIGO IIIC期亚组似乎从UAI中获益最大。然而，在多变量分析中，残留肿瘤负荷是生存的最强预测参数，其次是FIGO分期和UAI。UAI组的死亡率较低（0.6%）。
对于肿瘤扩散至上腹部的晚期卵巢癌患者，UAI是减瘤手术的重要组成部分，因为它能显著延长生存期。该手术似乎安全，死亡率低。与早期终止手术相比，因根治性手术联合UAI实现R1而非R2应更受青睐，因为这对患者预后有重大影响。
