Di Donato Violante, Caruso Giuseppe, Golia D'Augè Tullio, Perniola Giorgia, Palaia Innocenza, Tomao Federica, Muzii Ludovico, Pernazza Angelina, Della Rocca Carlo, Bogani Giorgio, Benedetti Panici Pierluigi, Giannini Andrea
Department of Maternal and Child Health and Urological Sciences, University of Rome Sapienza, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy.
Department of Medical-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Rome, Italy.
Arch Gynecol Obstet. 2025 Feb;311(2):429-436. doi: 10.1007/s00404-024-07775-w. Epub 2024 Oct 13.
To determine the prognostic impact of microscopic residual disease after neoadjuvant chemotherapy (NACT) in patients undergoing interval debulking surgery (IDS) for advanced epithelial ovarian cancer (AEOC).
Patients affected by FIGO stage IIIC-IV ovarian cancer undergoing IDS between October 2010 and April 2016 were selected. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier analysis.
In total, 98 patients were identified. Four patients (4.1%) were considered inoperable. Overall, 67 patients (out of 94; 71.3%) had macroscopic disease, equating Chemotherapy Response Score (CRS) 1 and 2, 7 (7.4%) had microscopic residuals, equating CRS3, rare CRS2, while 20 (21.3%) had both microscopic and macroscopic disease. Median OS and PFS were, respectively, 44 and 14 months in patients with no macroscopic residual disease (RD = 0) compared to 25 and 6 months, in patients with RD > 0 (OS: p = 0.001; PFS: p = 0.002). The median PFS was 9 months compared to 14 months for patients with more or less than 3 areas of microscopic disease at final pathologic evaluation (p = 0.04). The serum Ca125 dosage after NACT was higher in patients with RD > 0 compared to those without residue (986.31 ± 2240.7 µg/mL vs 215.72 ± 349.5 µg/mL; p = 0.01).
Even in the absence of macroscopic disease after NACT, the persistence of microscopic residuals predicts a poorer prognosis among AEOC patients undergoing IDS, with a trend towards worse PFS for patients with more than three affected areas. Removing all fibrotic residuals eventually hiding microscopic disease during IDS represents the key to improving the prognosis of these patients.
确定新辅助化疗（NACT）后微小残留病灶对接受间歇性肿瘤细胞减灭术（IDS）的晚期上皮性卵巢癌（AEOC）患者的预后影响。
选取2010年10月至2016年4月期间接受IDS的FIGO IIIC-IV期卵巢癌患者。采用Kaplan-Meier分析评估无进展生存期（PFS）和总生存期（OS）。
共确定98例患者。4例（4.1%）被认为无法手术。总体而言，94例中有67例（71.3%）存在肉眼可见病灶，化疗反应评分（CRS）为1和2级，7例（7.4%）有微小残留，CRS为3级，罕见CRS为2级，而20例（21.3%）既有微小病灶又有肉眼可见病灶。无肉眼可见残留病灶（RD = 0）的患者中位OS和PFS分别为44个月和14个月，而RD>0的患者分别为25个月和6个月（OS：p = 0.001；PFS：p = 0.002）。最终病理评估时，微小病灶区域多于或少于3个的患者中位PFS分别为9个月和14个月（p = 0.04）。与无残留的患者相比，RD>0的患者NACT后的血清Ca125剂量更高（986.31±2240.7µg/mL vs 215.72±349.5µg/mL；p = 0.01）。
即使NACT后无肉眼可见病灶，微小残留的存在也预示着接受IDS的AEOC患者预后较差，微小病灶区域超过三个的患者PFS有更差的趋势。在IDS期间清除所有最终隐藏微小病灶的纤维化残留是改善这些患者预后的关键。
