Karlsson Evelina, Vorobii Oksana, Silins Ilvars, Sundström Poromaa Inger, Stålberg Karin, Lomnytska Marta
Department of Women's and Children's Health, Uppsala University, SE-75185 Uppsala, Sweden.
Department of Women's and Children's Health, Uppsala University, SE-75185 Uppsala, Sweden.
Gynecol Oncol. 2025 Jun;197:121-128. doi: 10.1016/j.ygyno.2025.04.592. Epub 2025 May 8.
Complete cytoreductive surgery (CRS) is a gold standard in advanced ovarian cancer (OC) treatment, and most of the time, requires upper abdominal procedures. However, there is an enormous variation regarding the reported incidence of splenectomies, and the safety and prognosis of this procedure is largely unknown. The aim of this study was to evaluate the impact of splenectomy on surgical outcomes, complications and overall survival (OS) in primary OC surgery.
This prospective observational cohort study comprised patients with stage IIIC-IV OC who underwent primary CRS. Cases and controls were defined based on whether splenectomy had been performed or not. Comparisons between the groups were made using logistic regression models, receiver-operator characteristics and survival analyses i.e. Kaplan-Meier and Cox proportional hazard models.
Splenectomy was performed in 206/354 (58 %) patients, and among these - 170 (82.5 %) spleen metastases were identified. High peritoneal cancer index (PCI) was an independent predictor of splenectomy (aOR = 1.27 [95 % CI: 1.21-1.34]), with a PCI cut-off of 16 indicating need for splenectomy (AUC = 0.884). Splenectomy, PCI and surgical complexity score were all independent predictors of high-grade postoperative complications. Splenectomy, high PCI and completeness of cytoreduction were independent predictors of worse OS. Type of spleen metastasis (hilar/capsular versus parenchymal) did not influence OS.
Splenic metastatic involvement is common in OC and splenectomy is predicted by high PCI. Survival prognosis is equally impaired by all types of spleen metastasis. Splenectomy is an indicator of high tumour burden, high surgical complexity and high-grade postoperative complications, impaired survival and, indirectly, of cytoreduction success.
完全细胞减灭术（CRS）是晚期卵巢癌（OC）治疗的金标准，大多数情况下需要进行上腹部手术。然而，脾切除术的报告发生率差异巨大，且该手术的安全性和预后情况很大程度上未知。本研究旨在评估脾切除术对原发性OC手术的手术结果、并发症及总生存期（OS）的影响。
这项前瞻性观察性队列研究纳入了接受原发性CRS的IIIC-IV期OC患者。根据是否进行脾切除术定义病例组和对照组。使用逻辑回归模型、受试者工作特征曲线及生存分析（即Kaplan-Meier法和Cox比例风险模型）对两组进行比较。
354例患者中有206例（58%）接受了脾切除术，其中170例（82.5%）发现有脾转移。高腹膜癌指数（PCI）是脾切除术的独立预测因素（调整后比值比[aOR]=1.27[95%置信区间：1.21-1.34]），PCI临界值为16表明需要进行脾切除术（曲线下面积[AUC]=0.884）。脾切除术、PCI及手术复杂程度评分均是高级别术后并发症的独立预测因素。脾切除术、高PCI及细胞减灭的彻底性是OS较差的独立预测因素。脾转移类型（肝门/包膜型与实质型）不影响OS。
脾转移在OC中很常见，高PCI可预测脾切除术。所有类型的脾转移对生存预后的损害程度相同。脾切除术是肿瘤负荷高、手术复杂程度高、高级别术后并发症、生存受损以及间接提示细胞减灭术成功的一个指标。
