Recio F O, Piver M S, Hempling R E, Driscoll D L
Department of Gynecologic Oncology, Roswell Park Cancer Institute, Buffalo, New York, USA.
Cancer. 1996 Nov 15;78(10):2157-63. doi: 10.1002/(sici)1097-0142(19961115)78:10<2157::aid-cncr17>3.0.co;2-y.
This study was conducted to evaluate survival rates for patients with clear cell ovarian carcinoma who had platinum-based chemotherapy versus nonplatinum-based chemotherapy and the risk of thromboembolic complications.
One hundred and eleven evaluable patients with clear cell ovarian carcinoma who underwent primary surgery and postoperative therapy were retrospectively evaluated. Median follow-up was 21.3 months (range, 3-280 months). Patients treated with platinum-based chemotherapy and nonplatinum-based chemotherapy were evaluated according to stage, age, grade, extent of surgery, and development of thromboembolic complications. Patient populations were compared using the chi-square test. Estimated 5- and 10-year survivals for each group were calculated using the method of Kaplan and Meier. Differences in survival rates were calculated using the log rank test. The frequency of thromboembolic complications in the clear cell ovarian carcinoma group was compared with its frequency in a matched-control group of 109 patients with epithelial nonclear cell ovarian carcinoma.
Seventy-one patients were treated with nonplatinum-based chemotherapy and 40 patients were treated with platinum-based chemotherapy. There was no statistically significant difference in the characteristics of patient populations treated with platinum-based chemotherapy or nonplatinum-based chemotherapy. The estimated 5-year survival for clear cell ovarian carcinoma patients treated with platinum-based chemotherapy did not differ significantly from the estimated 5-year survival for patients with clear cell ovarian carcinoma treated with nonplatinum-based chemotherapy (36% vs. 32%; P = 0.23). Twelve patients with clear cell ovarian carcinoma developed thromboembolic complications remote from primary surgery, whereas in a matched-control group of patients with nonclear cell ovarian carcinoma treated with platinum-based chemotherapy, no patients developed a thromboembolic complications (P = 0.0004). Eight of 40 patients (20%) with clear cell ovarian carcinoma treated with platinum-based chemotherapy developed thromboembolic complications, whereas 4 of 71 patients (6%) treated with nonplatinum-based chemotherapy developed thromboembolic complications (P = 0.03). Multivariate logistic regression analysis demonstrated that the development of a thromboembolic complication was significantly related to clear cell ovarian carcinoma and platinum-based chemotherapy and had a significant (P = 0.009) negative impact on survival.
Platinum-based chemotherapy did not appear to improve survival compared with nonplatinum-based chemotherapy of patients with clear cell ovarian carcinoma. The combination of platinum-based chemotherapy and clear cell ovarian carcinoma significantly increases the risk for thromboembolic complications and has a significant negative impact on survival.
本研究旨在评估接受铂类化疗与非铂类化疗的透明细胞卵巢癌患者的生存率以及血栓栓塞并发症的风险。
对111例接受了初次手术及术后治疗的可评估透明细胞卵巢癌患者进行回顾性评估。中位随访时间为21.3个月（范围3 - 280个月）。根据分期、年龄、分级、手术范围及血栓栓塞并发症的发生情况，对接受铂类化疗和非铂类化疗的患者进行评估。采用卡方检验比较患者群体。使用Kaplan - Meier方法计算每组的估计5年和10年生存率。使用对数秩检验计算生存率差异。将透明细胞卵巢癌组的血栓栓塞并发症发生率与其在109例上皮性非透明细胞卵巢癌匹配对照组中的发生率进行比较。
71例患者接受非铂类化疗，40例患者接受铂类化疗。接受铂类化疗或非铂类化疗的患者群体特征无统计学显著差异。接受铂类化疗的透明细胞卵巢癌患者的估计5年生存率与接受非铂类化疗的透明细胞卵巢癌患者相比无显著差异（36%对32%；P = 0.23）。12例透明细胞卵巢癌患者在初次手术后发生血栓栓塞并发症，而在接受铂类化疗的非透明细胞卵巢癌匹配对照组中，无患者发生血栓栓塞并发症（P = 0.0004）。接受铂类化疗的40例透明细胞卵巢癌患者中有8例（20%）发生血栓栓塞并发症，而接受非铂类化疗的71例患者中有4例（6%）发生血栓栓塞并发症（P = 0.03）。多因素逻辑回归分析表明，血栓栓塞并发症的发生与透明细胞卵巢癌和铂类化疗显著相关，且对生存率有显著的负面影响（P = 0.009）。
与非铂类化疗相比，铂类化疗似乎并未提高透明细胞卵巢癌患者的生存率。铂类化疗与透明细胞卵巢癌的联合显著增加了血栓栓塞并发症的风险，并对生存率有显著的负面影响。
