PDF(Pubmed)
Abstract：
BACKGROUND: To evaluate the efficacy of cytoreductive surgery versus chemotherapy for the treatment of limited regional, platinum-resistant ovarian cancer (PROC).
METHODS: The clinical records of all patients with PROC treated in our center between March 2015 and March 2022 were retrospectively reviewed. We compared the oncology outcomes of patients who received cytoreduction or chemotherapy alone at relapse and presented information about postoperative adjuvant chemotherapy.
RESULTS: Among 52 patients with limited regional recurrence, 40.4% (21/52) underwent cytoreduction because of platinum resistance, and 59.6% (31/52) received chemotherapy alone. No residual disease (R0) was achieved in 20 patients (95.2%). The severe morbidity rate within 30 days after the surgery was 15%. The median follow-up was 70.6 months. Compared with the chemotherapy alone group, the surgery group with R0 had better progression-free survival (PFS) (10.6 vs. 5.1 months; hazard ratio (HR) = 0.421; P = 0.0035) and post-relapse survival (PRS) (32.6 vs. 16.3 months; HR = 0.478; P = 0.047), but there was no difference in overall survival (OS) between the two groups. Laparoscopy is associated with lesser intraoperative blood loss with no differences in survival and postoperative complications compared to the open approach (P = 0.0042). Subgroup survival analysis showed that compared with chemotherapy alone, surgery prolonged PFS in patients regardless of tumor size (greater than or equal to 4 cm or less). Surgery group patients who achieved R0 had an objective response rate (ORR) of 36.8% (7/19), among whom 40% (4/10) received platinum rechallenge chemotherapy and 33.3% (3/9) were administered non-platinum chemotherapy.
CONCLUSIONS: When well-selected PROC patients with limited regional recurrence achieved R0, their outcomes were superior to those of patients who received only chemotherapy with an acceptable morbidity rate. Laparoscope technology could be a reliable alternative surgical approach. The reintroduction of platinum agents may be considered following surgery. Further analyses in a larger population are warranted to elucidate the risks and benefits of this surgery and adjuvant chemotherapy strategy.
METHODS: The clinical records of all patients with PROC treated in our center between March 2015 and March 2022 were retrospectively reviewed. We compared the oncology outcomes of patients who received cytoreduction or chemotherapy alone at relapse and presented information about postoperative adjuvant chemotherapy.
RESULTS: Among 52 patients with limited regional recurrence, 40.4% (21/52) underwent cytoreduction because of platinum resistance, and 59.6% (31/52) received chemotherapy alone. No residual disease (R0) was achieved in 20 patients (95.2%). The severe morbidity rate within 30 days after the surgery was 15%. The median follow-up was 70.6 months. Compared with the chemotherapy alone group, the surgery group with R0 had better progression-free survival (PFS) (10.6 vs. 5.1 months; hazard ratio (HR) = 0.421; P = 0.0035) and post-relapse survival (PRS) (32.6 vs. 16.3 months; HR = 0.478; P = 0.047), but there was no difference in overall survival (OS) between the two groups. Laparoscopy is associated with lesser intraoperative blood loss with no differences in survival and postoperative complications compared to the open approach (P = 0.0042). Subgroup survival analysis showed that compared with chemotherapy alone, surgery prolonged PFS in patients regardless of tumor size (greater than or equal to 4 cm or less). Surgery group patients who achieved R0 had an objective response rate (ORR) of 36.8% (7/19), among whom 40% (4/10) received platinum rechallenge chemotherapy and 33.3% (3/9) were administered non-platinum chemotherapy.
CONCLUSIONS: When well-selected PROC patients with limited regional recurrence achieved R0, their outcomes were superior to those of patients who received only chemotherapy with an acceptable morbidity rate. Laparoscope technology could be a reliable alternative surgical approach. The reintroduction of platinum agents may be considered following surgery. Further analyses in a larger population are warranted to elucidate the risks and benefits of this surgery and adjuvant chemotherapy strategy.
摘要：
背景：为了评估细胞减灭术与化疗治疗有限区域的疗效，铂耐药卵巢癌（PROC）。
方法：回顾性回顾了2015年3月至2022年3月在我们中心接受PROC治疗的所有患者的临床记录。我们比较了复发时接受细胞减灭术或单独化疗的患者的肿瘤学结果，并提供了有关术后辅助化疗的信息。
结果：在52例局部复发的患者中，40.4％（21/52）由于铂电阻而进行了细胞减灭术，59.6%(31/52)单独接受化疗。20例患者（95.2%）未出现残留病（R0）。手术后30天内的严重发病率为15％。中位随访时间为70.6个月。与单纯化疗组相比,R0手术组的无进展生存期（PFS）（10.6vs.5.1个月；风险比（HR）=0.421；P=0.0035）和复发后生存率（PRS）（32.6vs.16.3个月；HR=0.478；P=0.047），但两组总生存期(OS)无差异.与开放方法相比，腹腔镜检查术中出血量少，生存率和术后并发症无差异（P=0.0042）。亚组生存分析显示,与单纯化疗相比,手术延长患者的PFS,无论肿瘤大小(大于或等于4cm或更小).达到R0的手术组患者的客观缓解率（ORR）为36.8％（7/19），其中40%(4/10)接受铂类再激发化疗,33.3%(3/9)接受非铂类化疗.
结论：当经过精心选择的局部复发有限的PROC患者达到R0时，其结果优于仅接受化疗且发病率可接受的患者。腹腔镜技术可能是一种可靠的替代手术方法。手术后可以考虑重新引入铂类药物。有必要在更大的人群中进行进一步的分析，以阐明这种手术和辅助化疗策略的风险和益处。
方法：回顾性回顾了2015年3月至2022年3月在我们中心接受PROC治疗的所有患者的临床记录。我们比较了复发时接受细胞减灭术或单独化疗的患者的肿瘤学结果，并提供了有关术后辅助化疗的信息。
结果：在52例局部复发的患者中，40.4％（21/52）由于铂电阻而进行了细胞减灭术，59.6%(31/52)单独接受化疗。20例患者（95.2%）未出现残留病（R0）。手术后30天内的严重发病率为15％。中位随访时间为70.6个月。与单纯化疗组相比,R0手术组的无进展生存期（PFS）（10.6vs.5.1个月；风险比（HR）=0.421；P=0.0035）和复发后生存率（PRS）（32.6vs.16.3个月；HR=0.478；P=0.047），但两组总生存期(OS)无差异.与开放方法相比，腹腔镜检查术中出血量少，生存率和术后并发症无差异（P=0.0042）。亚组生存分析显示,与单纯化疗相比,手术延长患者的PFS,无论肿瘤大小(大于或等于4cm或更小).达到R0的手术组患者的客观缓解率（ORR）为36.8％（7/19），其中40%(4/10)接受铂类再激发化疗,33.3%(3/9)接受非铂类化疗.
结论：当经过精心选择的局部复发有限的PROC患者达到R0时，其结果优于仅接受化疗且发病率可接受的患者。腹腔镜技术可能是一种可靠的替代手术方法。手术后可以考虑重新引入铂类药物。有必要在更大的人群中进行进一步的分析，以阐明这种手术和辅助化疗策略的风险和益处。
