Lamiman Kelly, Silver Michael, Hayek Judy, Hanusek Ryan, Sarmiento Lea, Kim Michael, Goncalves Nicole, Alagkiozidis Ioannis
Department of Gynecologic Oncology, Maimonides Medical Center, Brooklyn, NY 11220, USA.
Department of Gynecologic Oncology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA.
Cancers (Basel). 2025 Sep 2;17(17):2884. doi: 10.3390/cancers17172884.
Given the rising use of neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) in advanced epithelial ovarian cancer (EOC), we sought to assess practice trends in overall survival (OS), complete gross resection (R0), and postoperative mortality following debulking surgery. The National Cancer Database (NCDB) was used to identify 34,982 stage IIIC and IV EOC patients between 2010 and 2017 who underwent surgery. Annual proportions of patients receiving IDS and PDS were calculated. Median OS was estimated using the Kaplan-Meier method. Joinpoint models were fitted to evaluate surgical trends. Statistics were performed using SPSS and Joinpoint. Of 34,982 patients, 10,460 (29.9%) underwent IDS. IDS patients were older, more likely to have stage IV disease, and more likely to be non-White. Median OS was higher in the PDS group (54 vs. 38.8 months, < 0.001). Postoperative 90-day mortality was lower in the PDS group (1.7% vs. 2.4%, < 0.001), though IDS patients had a lower 30-day readmission rate (6.2% vs. 3.1%, < 0.001). IDS patients were less likely to undergo extensive surgery (27.4% vs. 36.7%, < 0.001) and more likely to achieve R0 resection (42% vs. 38.6%, < 0.001). The IDS rate increased from 18.9% to 40.6% (annual percentage change (APC): 11.8%, < 0.05) from 2010 to 2017. Median OS improved from 46.6 to 51 months (APC: 1.9%, < 0.05), driven by the PDS cohort. The R0 resection rate rose from 34.8 to 41% (APC: 2.65%, < 0.01), driven by the PDS cohort (APC: 2.83%, < 0.01). Postoperative 90-day mortality decreased from 2.4% to 1.5% (APC: -4.64%, < 0.05), due to a reduction in PDS patients (APC: -6.83%, < 0.05). There was no change in the rate of extensive surgery over time. In conclusion, from 2010 to 2017, increased triage of patients to NACT was accompanied by a higher R0 resection rate and reduced postoperative mortality in PDS patients, with no observed detriment to OS. This data suggests improvement in case selection between IDS and PDS.
鉴于新辅助化疗（NACT）联合间隔减瘤手术（IDS）在晚期上皮性卵巢癌（EOC）中的应用日益增加，我们试图评估减瘤手术后的总生存期（OS）、完全肉眼切除（R0）及术后死亡率的实践趋势。利用国家癌症数据库（NCDB）识别出2010年至2017年间接受手术的34982例IIIC期和IV期EOC患者。计算接受IDS和PDS（初始减瘤手术）患者的年度比例。使用Kaplan-Meier方法估计中位OS。采用Joinpoint模型评估手术趋势。使用SPSS和Joinpoint进行统计分析。在34982例患者中，10460例（29.9%）接受了IDS。IDS患者年龄更大，更有可能患有IV期疾病，且更有可能为非白人。PDS组的中位OS更高（54个月对38.8个月，P<0.001）。PDS组术后90天死亡率更低（1.7%对2.4%，P<0.001），尽管IDS患者的30天再入院率更低（6.2%对3.1%，P<0.001）。IDS患者接受广泛手术的可能性更小（27.4%对36.7%，P<0.001），更有可能实现R0切除（42%对38.6%，P<0.001）。从2010年到2017年，IDS率从18.9%升至40.6%（年度百分比变化（APC）：11.8%，P<0.05）。在PDS队列的推动下，中位OS从46.6个月提高到51个月（APC：1.9%，P<0.05）。R0切除率从34.8%升至41%（APC：2.65%，P<0.01），由PDS队列推动（APC：2.83%，P<0.01）。术后90天死亡率从2.4%降至1.5%（APC：-4.64%，P<0.05），这是由于PDS患者减少（APC：-6.83%，P<0.05）。随着时间推移，广泛手术率没有变化。总之，从2010年到2017年，将患者更多地分流至NACT伴随着更高的R0切除率以及PDS患者术后死亡率的降低，且未观察到对OS有不利影响。该数据表明在IDS和PDS之间的病例选择有所改善。
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