2种不同疗法对晚期上皮性卵巢癌的疗效及患者预后影响因素分析

doi:10.3969/j.issn.1004-616x.2023.02.009

Abstract

Abstract: OBJECTIVE： To compare the efficacy of neoadjuvant chemotherapy followed by interval debulking surgery with primary debulking surgery for advanced epithelial ovarian cancer，and to analyze the influencing factors of the prognosis. METHODS：From January 2010 to December 2019，advanced epithelial ovarian cancer patients (FIGO stage Ⅲ or Ⅳ) who were initially treated at the Department of Cancer Hospital of Shantou University Medical College，106 were selected and divided into two treatment groups：neoadjuvant chemotherapy with interval debulking surgery (NACT-IDS) and primary debulking surgery (PDS). Among the NACT-IDS group，patients were divided into 2 subgroups according to the preoperative chemotherapy cycles： the neoadjuvant chemotherapy ≤2 cycles (NACT-IDS-1) group and the neoadjuvant chemotherapy >2 cycles (NACT-IDS-2) group. Our patients were included into 67 cases in the NACT-IDS group (40 cases in the NACT-IDS-1 group，and 27 cases in the NACT-IDS-2 group) and 39 cases in the PDS group. Information about the general pathological characteristics， intraoperative bleeding， postoperative outcomes， and survival outcomes of the patients were analyzed retrospectively. Survival analysis was used to compare differences in overall survival (OS) and progression-free survival (PFS) between the groups of NACT-IDS and PDS and the two subgroups of NACT-IDS. T-test，chi-square test and Fisher's exact test were used to compare differences in intraoperative bleeding，operative time，and postoperative complications，etc. The Cox proportional hazards model was used to analyze relationships between clinicopathological characteristics and surgery-related characteristics with prognosis. RESULTS：Among the 106 patients，58 (54.7%) died and the median follow-up time was 46 months. The median OS was 44 and 42 months in the NACT-IDS and PDS groups，respectively， and the median PFS was 21 months in both groups. The differences in median OS and median PFS between the NACT-IDS and PDS groups and between the NACT-IDS subgroups were not statistically significant (all P>0.05). Compared with the PDS group， the NACT-IDS group showed significant differences in intraoperative bleeding，operative time，incidence of postoperative complications，and time to start chemotherapy after surgery (all P<0.05). The results of the multivariable COX proportional hazards model showed that residual disease (incomplete resection) versus no residual disease (complete resection) was statistically significant on OS [HR= 2.82， 95% CI(1.20， 6.63)， P=0.017]； the effect of normalization of CA-125 after 4 cycles of postoperative chemotherapy was statistically significant on both OS and PFS compared with those who did not [HR=0.39， 95%CI(0.18，0.88)，P=0.022；HR=0.34，95%CI(0.17，0.71)，P=0.004]. CONCLUSION：NACT-IDS improves the quality of surgery compared with PDS for advanced epithelial ovarian cancer，but does not significantly enhance the overall survival benefit，and suggests early IDS as soon as conditions permit. Residual disease and whether CA-125 recovered to normal after 4 cycles of postchemotherapy were independent prognostic factors affecting OS in advanced epithelial ovarian cancers.

Key words: advanced epithelial ovarian cancer, interval debulking surgery, primary debulking surgery, prognosis

CLC Number:

R737.31

TAN Jianhua, LAI Yaozhen, TANG Lihua, ZHOU Li. Efficacy and prognostic values of two treatments for advanced epithelial ovarian cancers[J]. Carcinogenesis, Teratogenesis & Mutagenesis, 2023, 35(2): 131-138.

References

[1] SUNG H, FERLAY J, SIEGEL R L, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249.
[2] XIA C F, DONG X S, LI H, et al. Cancer statistics in China and United States, 2022: profiles, trends, and determinants[J]. Chin Med J (Engl), 2022, 135(5): 584-590.
[3] WRIGHT A A, BOHLKE K, ARMSTRONG D K, et al. Neoadjuvant chemotherapy for newly diagnosed, advanced ovarian cancer: society of gynecologic oncology and American society of clinical oncology clinical practice guideline[J]. J Clin Oncol, 2016, 34(28): 3460-3473.
[4] VERGOTE I, TROPÉ C G, AMANT F, et al. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer[J]. N Engl J Med, 2010, 363(10): 943-953.
[5] KEHOE S, HOOK J, NANKIVELL M, et al. Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trial[J]. Lancet, 2015, 386(9990): 249-257.
[6] ONDA T, SATOH T, SAITO T, et al. Comparison of survival between upfront primary debulking surgery versus neoadjuvant chemotherapy for stage III/IV ovarian, tubal and peritoneal cancers in phase III randomized trial: JCOG0602[J]. J Clin Oncol, 2018, 36(Sup 15): 5500.
[7] FAGOTTI A, FERRANDINA M G, VIZZIELLI G, et al. Randomized trial of primary debulking surgery versus neoadjuvant chemotherapy for advanced epithelial ovarian cancer (SCORPION-NCT01461850) [J]. Int J Gynecol Cancer, 2020, 30(11): 1657-1664.
[8] 卢淮武, 吴斌, 许妙纯, 等.《2022 NCCN卵巢癌包括输卵管癌及原发性腹膜癌临床实践指南(第1版)》解读[J]. 中国实用妇科与产科杂志, 2022, 38(3): 310-318.
[9] PLETT H, FILIPPOVA O T, GARBI A, et al. Role of delayed interval debulking for persistent residual disease after more than 5cycles of chemotherapy for primary advanced ovarian cancer. An international multicenter study[J]. Gynecol Oncol, 2020, 159(2): 434-441.
[10] HOROWITZ N S, MILLER A, RUNGRUANG B, et al. Does aggressive surgery improve outcomes? Interaction between preoperative disease burden and complex surgery in patients with advanced-stage ovarian cancer: an analysis of GOG 182[J]. J Clin Oncol, 2015, 33(8): 937-943.
[11] XU Z M, BECERRA A Z, JUSTINIANO C F, et al. Complications and survivorship trends after primary debulking surgery for ovarian cancer[J]. J Surg Res, 2020, 246: 34-41.
[12] CHI D S, ZIVANOVIC O, LEVINSON K L, et al. The incidence of major complications after the performance of extensive upper abdominal surgical procedures during primary cytoreduction of advanced ovarian, tubal, and peritoneal carcinomas[J]. Gynecol Oncol, 2010, 119(1): 38-42.
[13] NASIOUDIS D, KAHN R, CHAPMAN-DAVIS E, et al. Impact of hospital surgical volume on complete gross resection (CGR) rates following primary debulking surgery for advanced stage epithelial ovarian carcinoma[J]. Gynecol Oncol, 2019, 154(2): 401-404.
[14] BRISTOW R E, EISENHAUER E L, SANTILLAN A, et al. Delaying the primary surgical effort for advanced ovarian cancer: a systematic review of neoadjuvant chemotherapy and interval cytoreduction[J]. Gynecol Oncol, 2007, 104(2): 480-490.
[15] MORGAN ROBERT J, ALVAREZ RONALD D, ARMSTRONG DEBORAH K, et al. Ovarian cancer, version 3.2012[J]. J Natl Compr Cancer Netw JNCCN, 2012, 10(11): 1339-1349.
[16] VERGOTE I, COENS C, NANKIVELL M, et al. Neoadjuvant chemotherapy versus debulking surgery in advanced tuboovarian cancers: pooled analysis of individual patient data from the EORTC 55971 and CHORUS trials[J]. Lancet Oncol, 2018, 19(12): 1680-1687.
[17] NARASIMHULU D M, KUMAR A, WEAVER A L, et al. Using an evidence-based triage algorithm to reduce 90-day mortality after primary debulking surgery for advanced epithelial ovarian cancer[J]. Gynecol Oncol, 2019, 155(1): 58-62.
[18] COLOMBO P E, LABAKI M, FABBRO M, et al. Impact of neoadjuvant chemotherapy cycles prior to interval surgery in patients with advanced epithelial ovarian cancer[J]. Gynecol Oncol, 2014, 135(2): 223-230.
[19] BRISTOW R E, CHI D S. Platinum-based neoadjuvant chemotherapy and interval surgical cytoreduction for advanced ovarian cancer: a meta-analysis[J]. Gynecol Oncol, 2006, 103(3): 1070-1076.
[20] NITECKI R, FLEMING N D, FELLMAN B M, et al. Timing of surgery in patients with partial response or stable disease after neoadjuvant chemotherapy for advanced ovarian cancer[J]. Gynecol Oncol, 2021, 161(3): 660-667.

Efficacy and prognostic values of two treatments for advanced epithelial ovarian cancers

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

References

Related Articles 15

Recommended Articles

Metrics

Comments

[1]	HUANG Lidan, WU Yueming, WANG Yadi, TAN Qi. Relationships between VEGF-A protein expression and EGFR mutation in patients with lung adenocarcinomas and its clinical significance [J]. Carcinogenesis, Teratogenesis & Mutagenesis, 2023, 35(2): 116-120.
[2]	HU Xueyi, SHEN Feng, WU Lun, SU Caiwu, WEI Jian. SPON2 expression in papillary thyroid carcinomas and its clinical significance [J]. Carcinogenesis, Teratogenesis & Mutagenesis, 2023, 35(1): 9-14.
[3]	XU Hao, HU Bichuan, ZOU Wei, DUAN Yabin. Identification of prognostic factors among patients with stage Ⅲ gastric cancer undergoing radical resection [J]. Carcinogenesis, Teratogenesis & Mutagenesis, 2023, 35(1): 30-36.
[4]	LI Ziyao, ZHANG Haiping, MADINIYET·Niyaz, JULATI·Ainiwaer, ZHANG Liwei, EDRIS·Awut. Clinicopathological significance of cystatin 6 protein expression in Kazakh esophageal squamous cell carcinoma [J]. Carcinogenesis, Teratogenesis & Mutagenesis, 2022, 34(6): 429-433,438.
[5]	YU Yunliang, WANG Lili, LI Ting, FENG Jiankai. Correlations among P2RX1,prognosis and immune cells infiltration in lung adenocarcinoma [J]. Carcinogenesis, Teratogenesis & Mutagenesis, 2022, 34(5): 353-360,365.
[6]	ZHANG Haizhi, WEN Xiaofen, HUANG Binliang, LIN Hui, XUE Wenwu, ZENG De, LIN Danxia. Expression and clinical significance of SLC50A1 in breast carcinomas [J]. Carcinogenesis, Teratogenesis & Mutagenesis, 2022, 34(5): 373-377.
[7]	ZHANG Yuling, LIU Ditian, CHEN Chunfa. Impact of CD68 macrophage infiltration on prognosis in primary small cell esophageal carcinoma [J]. Carcinogenesis, Teratogenesis & Mutagenesis, 2022, 34(4): 279-283.
[8]	WANG Xujuan, LUO Yongxin, LI Chenqiang, WANG Rujin, ZHENG Tingting. Predictive values of preoperative laboratory indices dNLR, SII and CRP/ALB on recurrences and metastases in breast cancer patient [J]. Carcinogenesis, Teratogenesis & Mutagenesis, 2022, 34(4): 284-288,323.
[9]	LIANG Feng, ZHANG Wei, LI Fei, WANG Shengjie, DU Yujing, ZHANG Yingchun. Expressions of lncRNA CASC9 in colorectal cancer and its relationship with clinical prognosis [J]. Carcinogenesis, Teratogenesis & Mutagenesis, 2022, 34(2): 110-113.
[10]	PENG Youbin, LIN Hao, LI Ming, HUANG Haihua. Expression of TPX2 and its clinicalsignificance in non-muscle-invasive bladder cancer [J]. Carcinogenesis, Teratogenesis & Mutagenesis, 2022, 34(1): 30-34.
[11]	JIAO Wenpeng, HOU Lin, CUI Meijuan, JIAO Wenjing, MA Ming, ZHANG Jinyan. Expression of miR-93-5p and miR-106b-5p in alcohol-related liver cancer and its clinical significance [J]. Carcinogenesis, Teratogenesis & Mutagenesis, 2021, 33(6): 430-434.
[12]	GAO Xiaobin, WU Xueliang, WANG Shengjie, SUN Guangyuan, WANG Wenjing, LIANG Feng, ZHAO Yifeng, LIU Zhenxian, ZHANG Yingchun. Expression of TRIM59 and its correlations with clinicopathological features in colorectal cancers [J]. Carcinogenesis, Teratogenesis & Mutagenesis, 2021, 33(6): 446-450.
[13]	JIAO Wenjing, ZHANG Jinyan, MA Ming, GUO Xiujuan, FENG Junhua, SHAO Junguo, JIAO Wenpeng. Expression and clinical significance of MTDH and FoxM1 in hepatocellular carcinomas [J]. Carcinogenesis, Teratogenesis & Mutagenesis, 2021, 33(5): 349-353,359.
[14]	ZHANG Shimin, ZHAO Ruijun. Expression of protein tyrosine phosphatase receptor J in breast cancer tissues and its relationship with clinical prognosis [J]. Carcinogenesis, Teratogenesis & Mutagenesis, 2021, 33(4): 276-279,285.
[15]	LIU Xiaoxia, LI Weixia, LI Zhijia, SU Zhenjun, DUAN Xiaohui, HAN Weiwen, WANG Yunxiao, HE Xiaolei, Lu Linlin, JIA Jinhai. Correlations between glutathione peroxidase in serum and clinicopathological outcomes of advanced non-small cell lung cancer [J]. Carcinogenesis, Teratogenesis & Mutagenesis, 2021, 33(4): 286-290,295.