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Abstract：
BACKGROUND: Complete macroscopic resection is a key factor associated with prolonged survival in ovarian cancer. However, most evidence derives from high-grade serous ovarian carcinoma, and the benefit of complete macroscopic resection in other histotypes is poorly characterized. We sought to determine which histotypes derive the greatest benefit from complete macroscopic resection to better inform future decisions on radical cytoreductive efforts.
METHODS: We performed multivariable analysis of disease-specific survival across 2 independent patient cohorts to determine the magnitude of benefit associated with complete macroscopic resection within each histotype.
RESULTS: Across both cohorts (Scottish: n = 1622; Surveillance, Epidemiology, and End Results [SEER]: n = 18 947), complete macroscopic resection was associated with prolonged disease-specific survival; this was more marked in the Scottish cohort (multivariable hazard ratio [HR] = 0.44, 95% confidence interval [CI] = 0.37 to 0.52 vs HR = 0.59, 95% CI = 0.57 to 0.62 in SEER). In both cohorts, clear cell ovarian carcinoma was among the histotypes to benefit most from complete macroscopic resection (multivariable HR = 0.23 and HR = 0.50 in Scottish and SEER cohorts, respectively); high-grade serous ovarian carcinoma patients demonstrated highly statistically significant and clinically meaningful survival benefit, but this was of lower magnitude than in clear cell ovarian carcinoma and endometrioid ovarian carcinoma across both cohorts. The benefit derived in low-grade serous ovarian carcinoma is also high (multivariable HR = 0.27 in Scottish cohort). Complete macroscopic resection was associated with prolonged survival in mucinous ovarian carcinoma patients in the SEER cohort (multivariable HR = 0.65), but the association failed to reach statistical significance in the Scottish cohort.
CONCLUSIONS: The overall ovarian cancer patient population demonstrates clinically significant survival benefit associated with complete macroscopic resection; however, the magnitude of benefit differs between histotypes.
METHODS: We performed multivariable analysis of disease-specific survival across 2 independent patient cohorts to determine the magnitude of benefit associated with complete macroscopic resection within each histotype.
RESULTS: Across both cohorts (Scottish: n = 1622; Surveillance, Epidemiology, and End Results [SEER]: n = 18 947), complete macroscopic resection was associated with prolonged disease-specific survival; this was more marked in the Scottish cohort (multivariable hazard ratio [HR] = 0.44, 95% confidence interval [CI] = 0.37 to 0.52 vs HR = 0.59, 95% CI = 0.57 to 0.62 in SEER). In both cohorts, clear cell ovarian carcinoma was among the histotypes to benefit most from complete macroscopic resection (multivariable HR = 0.23 and HR = 0.50 in Scottish and SEER cohorts, respectively); high-grade serous ovarian carcinoma patients demonstrated highly statistically significant and clinically meaningful survival benefit, but this was of lower magnitude than in clear cell ovarian carcinoma and endometrioid ovarian carcinoma across both cohorts. The benefit derived in low-grade serous ovarian carcinoma is also high (multivariable HR = 0.27 in Scottish cohort). Complete macroscopic resection was associated with prolonged survival in mucinous ovarian carcinoma patients in the SEER cohort (multivariable HR = 0.65), but the association failed to reach statistical significance in the Scottish cohort.
CONCLUSIONS: The overall ovarian cancer patient population demonstrates clinically significant survival benefit associated with complete macroscopic resection; however, the magnitude of benefit differs between histotypes.
摘要：
背景：完全宏观切除（CMR）是延长卵巢癌生存期的关键因素。然而,大多数证据来自高级别浆液性卵巢癌（HGSOC），而CMR在其他组织型中的益处缺乏表征。我们试图确定哪些组织型从CMR中获得最大的益处，以更好地指导未来关于激进细胞还原努力的决定。
方法：我们对两个独立的患者队列进行了疾病特异性生存（DSS）的多变量分析，以确定每个组织型中与CMR相关的获益程度。
结果：在这两个队列中（苏格兰，n=1622；SEER，n=18947)，CMR与长期DSS相关；这在苏格兰队列中更为明显（SEER的多变量HR0.44，95CI0.37-0.52vs0.59，95CI0.57-0.62）。在这两个队列中，透明细胞卵巢癌（CCOC）是最受益于CMR的组织学类型之一（苏格兰和SEER队列中的多变量HR0.23和0.50）；HGSOC病例显示出非常显着和临床意义的生存获益，但在这两个队列中,这一幅度低于CCOC和子宫内膜样卵巢癌(EnOC).低级别浆液性卵巢癌的获益也很高（苏格兰队列中的多变量HR0.27）。在SEER队列中，CMR与粘液性卵巢癌（MOC）患者的生存期延长相关（多变量HR0.65），但相关因素在苏格兰队列中未能达到统计学意义。
结论：总体卵巢癌患者群体表现出与CMR相关的显著生存获益；然而，不同组织型的获益程度不同。
方法：我们对两个独立的患者队列进行了疾病特异性生存（DSS）的多变量分析，以确定每个组织型中与CMR相关的获益程度。
结果：在这两个队列中（苏格兰，n=1622；SEER，n=18947)，CMR与长期DSS相关；这在苏格兰队列中更为明显（SEER的多变量HR0.44，95CI0.37-0.52vs0.59，95CI0.57-0.62）。在这两个队列中，透明细胞卵巢癌（CCOC）是最受益于CMR的组织学类型之一（苏格兰和SEER队列中的多变量HR0.23和0.50）；HGSOC病例显示出非常显着和临床意义的生存获益，但在这两个队列中,这一幅度低于CCOC和子宫内膜样卵巢癌(EnOC).低级别浆液性卵巢癌的获益也很高（苏格兰队列中的多变量HR0.27）。在SEER队列中，CMR与粘液性卵巢癌（MOC）患者的生存期延长相关（多变量HR0.65），但相关因素在苏格兰队列中未能达到统计学意义。
结论：总体卵巢癌患者群体表现出与CMR相关的显著生存获益；然而，不同组织型的获益程度不同。
