Eisenkop S M, Friedman R L, Wang H J
Center for Gynecologic Oncology, Encino, CA 91436, USA.
Cancer. 1995 Nov 1;76(9):1606-14. doi: 10.1002/1097-0142(19951101)76:9<1606::aid-cncr2820760917>3.0.co;2-h.
The prognosis for patients with recurrent epithelial ovarian cancer is poor. Most are treated with salvage chemotherapy. The role of secondary cytoreductive surgery is controversial. Hence, this prospective study was undertaken to determine the feasibility and benefit of secondary cytoreductive surgery before the administration of salvage chemotherapy.
Between 1990 and 1994, 36 patients with recurrent epithelial ovarian cancer underwent secondary surgical cytoreduction. All had prior primary cytoreductive surgery, platin-based chemotherapy, and had relapsed at least 6 months after completion of primary treatment. The goal was the excision of all macroscopic disease before initiation of chemotherapy or radiation therapy. Statistical analysis was undertaken to determine which clinical and pathologic variables influenced the feasibility of complete excision as well as morbidity, mortality, survival benefit, and quality of life resulting from secondary cytoreductive surgery.
Thirty (83.0%) patients had complete surgical excisions. The probability of a complete excision was influenced by Gynecologic Oncology Group (GOG) performance status (0-2 vs. 3, P = 0.05) and size of largest tumor deposit (< 10 cm vs. > 10 cm, P = 0.03). Eleven (30.1%) patients experienced morbidity and 1 (2.8%) died postoperatively. Of 27 symptomatic patients with at least 3 months of follow-up, 26 (96.2%) had resolution or improvement of their symptoms. Of 25 followed for at least 6 months postoperatively, 23 (92.0%) had a GOG performance status of 0 or 1. Survival was adversely influenced by the administration of salvage chemotherapy before surgery (P = 0.02), a preoperative GOG performance status of 3 (P = 0.01), and a brief disease free interval after completion of primary treatment (P = 0.01). The median survival was extended for patients completely resected before salvage chemotherapy or radiation, compared with those with macroscopic residual disease remaining (43 vs. 5 months, P = 0.03).
Complete secondary cytoreductive surgery for recurrent epithelial ovarian cancer is technically feasible and has an acceptable operative complication rate. Survival is significantly improved for patients having complete resection. Subsequent relief of symptoms and performance status are excellent.
复发性上皮性卵巢癌患者的预后较差。大多数患者接受挽救性化疗。二次减瘤手术的作用存在争议。因此，开展了这项前瞻性研究，以确定在进行挽救性化疗之前进行二次减瘤手术的可行性和益处。
1990年至1994年间，36例复发性上皮性卵巢癌患者接受了二次手术减瘤。所有患者均曾接受过初次减瘤手术和铂类化疗，且在初次治疗完成后至少6个月复发。目标是在开始化疗或放疗前切除所有肉眼可见的病灶。进行统计分析以确定哪些临床和病理变量影响完全切除的可行性以及二次减瘤手术导致的发病率、死亡率、生存获益和生活质量。
30例（83.0%）患者实现了完全手术切除。完全切除的可能性受妇科肿瘤学组（GOG）体能状态（0 - 2级与3级，P = 0.05）和最大肿瘤灶大小（< 10 cm与> 10 cm，P = 0.03）影响。11例（30.1%）患者出现并发症，1例（2.8%）术后死亡。在27例有症状且至少随访3个月的患者中，26例（96.2%）症状缓解或改善。在25例术后至少随访6个月的患者中，23例（92.0%）的GOG体能状态为0或1级。术前进行挽救性化疗（P = 0.02）、术前GOG体能状态为3级（P = 0.01）以及初次治疗完成后无病间期短（P = 0.01）对生存有不利影响。与仍有肉眼可见残留病灶的患者相比，在挽救性化疗或放疗前完全切除的患者中位生存期延长（43个月对5个月，P = 0.03）。
复发性上皮性卵巢癌的完全二次减瘤手术在技术上是可行的，手术并发症发生率可接受。完全切除的患者生存显著改善。随后症状缓解且体能状态良好。
