Caruso Giuseppe, Kumar Amanika, Langstraat Carrie L, McGree Michaela E, Fought Angela J, Harrington Shariska, Nasioudis Dimitrios, Aletti Giovanni D, Colombo Nicoletta, Giuntoli Robert L, Cliby William
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN, USA; Department of Gynecology, IEO European Institute of Oncology IRCCS, Milan, Italy; Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN, USA.
Gynecol Oncol. 2025 Apr;195:106-114. doi: 10.1016/j.ygyno.2025.03.016. Epub 2025 Mar 15.
Textbook Oncologic Outcome (TOO) is a composite measure that strongly predicts survival after surgery for advanced epithelial ovarian cancer (AEOC), regardless of approach: primary (PDS) or interval debulking surgery (IDS). We aimed to identify risk factors associated with failure to achieve TOO and to receive standard treatment (surgery and chemotherapy) for AEOC.
Patients diagnosed with AEOC between 2008 and 2019 were identified using the National Cancer Database. TOO was defined as achieving complete cytoreduction, hospital stay <10 days, no 30-day readmission, adjuvant chemotherapy initiation <42 days, and 90-day survival. Logistic regression models were used to identify factors associated with TOO and receipt of standard treatment.
Among 58,635 AEOC patients, 49% received standard treatment. Of the 21,657 patients who underwent surgery, 51.4% received PDS and 48.6% IDS. For PDS multivariable analysis, factors associated with lower likelihood to achieve TOO included age >75 years (vs <60; OR 0.47, 95% CI 0.38-0.58), Black race (vs White; OR 0.73, 95% CI 0.59-0.90), government insurance (vs private; OR 0.82, 95% CI 0.73-0.92), high surgical complexity (vs low; OR 0.62, 95% CI 0.56-0.68), and median surgical volume ≤5 cases/year (vs ≥20; OR 0.75, 95% CI 0.63-0.89). For IDS, similar associations were observed for government insurance (OR 0.87, 95% CI, 0.80-0.96), high surgical complexity (OR 0.61, 95% CI 0.55-0.66), and median surgical volume ≤5 cases/year (OR 0.60, 95% CI 0.52-0.70).
Several factors are associated with lower likelihood of achieving TOO after treatment for AEOC. Some of these factors (age, race, payor type) reflect disparities in care; others (facility volume, surgical complexity) highlight the need for referral to high-volume centers for initial treatment planning.
教科书式肿瘤学结局（TOO）是一种综合指标，无论采用何种手术方式：初次手术（PDS）或间隔减瘤手术（IDS），它都能强有力地预测晚期上皮性卵巢癌（AEOC）手术后的生存率。我们旨在确定与未达到TOO以及未接受AEOC标准治疗（手术和化疗）相关的风险因素。
利用国家癌症数据库识别2008年至2019年间被诊断为AEOC的患者。TOO的定义为实现完全细胞减灭、住院时间<10天、无30天再入院、辅助化疗开始时间<42天以及90天生存率。采用逻辑回归模型确定与TOO及接受标准治疗相关的因素。
在58635例AEOC患者中，49%接受了标准治疗。在21657例接受手术的患者中，51.4%接受了PDS，48.6%接受了IDS。对于PDS多变量分析，与达到TOO可能性较低相关的因素包括年龄>75岁（vs<60岁；OR 0.47，95%CI 0.38 - 0.58）、黑人种族（vs白人；OR 0.73，95%CI 0.59 - 0.90）、政府保险（vs私人保险；OR 0.82，95%CI 0.73 - 0.92）、手术复杂性高（vs低；OR 0.62，95%CI 0.56 - 0.68）以及手术量中位数≤5例/年（vs≥20例；OR 0.75，95%CI 0.63 - 0.89）。对于IDS，在政府保险（OR 0.87，95%CI 0.80 - 0.96）、手术复杂性高（OR 0.61，95%CI 0.55 - 0.66）以及手术量中位数≤5例/年（OR 0.60，95%CI 0.52 - 0.70）方面观察到类似的关联。
几个因素与AEOC治疗后达到TOO的可能性较低相关。其中一些因素（年龄、种族、支付类型）反映了医疗保健方面的差异；其他因素（机构手术量、手术复杂性）凸显了在初始治疗规划时转诊至手术量大的中心的必要性。
