Eisenkop S M, Friedman R L, Wang H J
Women's Cancer Center, Encino-Tarzana, 5525 Etiwanda Avenue, Suite 311, Tarzana, California 91356, USA.
Gynecol Oncol. 1998 May;69(2):103-8. doi: 10.1006/gyno.1998.4955.
Despite correlation between the completeness of surgical cytoreduction and survival for patients with advanced ovarian cancer, relatively few undergo complete cytoreduction. This study was initiated to prospectively determine the ability to surgically eliminate all visible disease in patients with stage IIIC and IV epithelial ovarian cancer and the associated impact on survival.
Between 1990 and 1996, 163 consecutive patients underwent primary cytoreduction. The goal was the excision or ablation of all visible disease prior to initiation of systemic platinum-based combination chemotherapy. A multivariate analysis determined which clinical and pathologic variables influenced the probability of achieving complete cytoreduction (logistic regression) and survival (Cox proportional hazards model).
One hundred thirty-nine patients (85.3%) underwent removal of all visible tumor, 22 (13.5%) had cytoreduction to </=1 cm residual disease, and 2 (1.2%) had unresected bulky disease. The median and estimated 5-year survival for the entire cohort was 54 months and 48%, respectively. The probability of achieving complete cytoreduction was influenced independently by the preoperative Gynecologic Oncology Group performance status (0-1 vs 2-3, P = 0.04), the number of mesenteric and intestinal serosal implants (</=75 vs >75 implants, P = 0.005), and stage (IIIC vs IV, P = 0.006). The probability of survival was independently influenced by age (</=61 vs >61 years, P = 0.003), volume of ascites (</=1 vs >1 liter, P = 0.01), stage (IIIC vs IV, P = 0.04), histology (clear cell and mucinous vs all other, P = 0.03), and the completeness of cytoreductive operation (complete vs incomplete cytoreduction, P = 0.02).
Complete cytoreduction is possible for the majority of patients and improves survival, even compared to operations with minimal (</=1 cm) residual disease. Unless their medical condition prohibits anesthesia and surgery, patients with advanced epithelial ovarian cancer should undergo primary cytoreductive surgery with the intention of complete tumor removal.
尽管晚期卵巢癌患者的手术细胞减灭术的彻底性与生存率之间存在相关性，但相对较少的患者能实现完全细胞减灭。本研究旨在前瞻性地确定IIIC期和IV期上皮性卵巢癌患者通过手术消除所有可见病灶的能力以及对生存的相关影响。
1990年至1996年间，163例连续患者接受了初次细胞减灭术。目标是在开始基于铂类的全身联合化疗之前切除或消融所有可见病灶。多变量分析确定了哪些临床和病理变量影响实现完全细胞减灭的概率（逻辑回归）和生存率（Cox比例风险模型）。
139例患者（85.3%）切除了所有可见肿瘤，22例（13.5%）实现细胞减灭至残留病灶≤1 cm，2例（1.2%）有未切除的大块病灶。整个队列的中位生存期和估计5年生存率分别为54个月和48%。实现完全细胞减灭的概率独立地受到术前妇科肿瘤学组体能状态（0 - 1 vs 2 - 3，P = 0.04）、肠系膜和肠浆膜种植灶数量（≤75个种植灶vs＞75个种植灶，P = 0.005）以及分期（IIIC期vs IV期，P = 0.006）的影响。生存率独立地受到年龄（≤61岁vs＞61岁，P = 0.003）、腹水量（≤1升vs＞1升，P = 0.01）、分期（IIIC期vs IV期，P = 0.04）、组织学类型（透明细胞和黏液性vs所有其他类型，P = 0.03）以及细胞减灭手术的彻底性（完全细胞减灭vs不完全细胞减灭，P = 0.02）的影响。
对于大多数患者来说，完全细胞减灭是可能的，并且能提高生存率，即使与残留病灶最小（≤1 cm）的手术相比也是如此。除非患者的身体状况禁止麻醉和手术，晚期上皮性卵巢癌患者应接受旨在完全切除肿瘤的初次细胞减灭手术。
