Zhao Lei, Cheng Gang, Zhou Xin, Xu Congya, Ge Mengni, Zhou Qin
Department of Gynecology, Kunshan Hospital of Traditional Chinese Medicine, Jiangsu, Kunshan, 215300, China.
Emergency Department, Kunshan Hospital of Traditional Chinese Medicine, Jiangsu, Kunshan, 215300, China.
World J Surg Oncol. 2025 Apr 4;23(1):119. doi: 10.1186/s12957-025-03769-3.
Cytoreductive surgery serves as a cornerstone intervention for advanced epithelial ovarian cancer (EOC), yet some patients decline the procedure despite clinical recommendations. This study aimed to evaluate survival outcomes and identify sociodemographic and clinical factors associated with this decision in advanced EOC patients.
A retrospective analysis of EOC cases from the Surveillance, Epidemiology, and End Results (SEER) database (2004-2021) was conducted, including patients with stage III/IV EOC recommended for surgery. Patients were categorized into surgical and non-surgical cohorts. Propensity Score Matching (PSM) was applied to adjust for baseline differences, and survival outcomes were compared using Kaplan-Meier and Cox proportional hazards models. Logistic regression analysis was performed to identify predictors of surgery declination.
Of the 21,988 patients included, 363 (1.7%) were in the non-surgery group. Following a median follow-up of 33 months, patients in the non-surgical cohort demonstrated significantly lower overall survival (OS) compared to the surgical cohort, with mean OS of 17.8 months versus 45.8 months, respectively (P < 0.001). The Cox model showed increased mortality risk for the non-surgical group post-PSM (HR, 1.87; 95% CI, 1.62-2.15). Non-Hispanic Black, older age, lower household income, nonmetropolitan residence, and unmarried status were associated with higher odds of surgery refusal.
Declining surgery is associated with significantly poorer survival in advanced EOC. Sociodemographic factors play a key role in surgical decision-making, underscoring the need for targeted interventions to improve access to surgical care and reduce disparities in EOC treatment outcomes. Further studies should explore the impact of specific chemotherapy and comorbidities on surgery refusal and survival.
减瘤手术是晚期上皮性卵巢癌（EOC）的基石性干预措施，但仍有一些患者尽管有临床建议，却拒绝接受该手术。本研究旨在评估晚期EOC患者的生存结局，并确定与这一决定相关的社会人口统计学和临床因素。
对监测、流行病学和最终结果（SEER）数据库（2004 - 2021年）中的EOC病例进行回顾性分析，纳入推荐进行手术的III/IV期EOC患者。将患者分为手术组和非手术组。应用倾向得分匹配（PSM）来调整基线差异，并使用Kaplan-Meier法和Cox比例风险模型比较生存结局。进行逻辑回归分析以确定拒绝手术的预测因素。
在纳入的21988例患者中，363例（1.7%）在非手术组。中位随访33个月后，非手术组患者的总生存期（OS）显著低于手术组，非手术组的平均OS为17.8个月，而手术组为45.8个月（P < 0.001）。Cox模型显示PSM后非手术组的死亡风险增加（HR，1.87；95%CI，1.62 - 2.15）。非西班牙裔黑人、年龄较大、家庭收入较低、居住在非大都市地区以及未婚状态与拒绝手术的几率较高相关。
拒绝手术与晚期EOC患者的生存明显较差相关。社会人口统计学因素在手术决策中起关键作用，强调需要有针对性的干预措施，以改善手术治疗的可及性并减少EOC治疗结局的差异。进一步的研究应探讨特定化疗和合并症对拒绝手术及生存的影响。
