基于SEER数据库的新辅助化疗与初始肿瘤细胞减灭术治疗ⅢC和Ⅳ期卵巢上皮癌预后研究

Prognosis of neoadjuvant chemotherapy and primary debulking surgery in the treatment of stage ⅢC and Ⅳ epithelial ovarian cancer based on SEER database

目的对比新辅助化疗(NACT)与初始肿瘤细胞减灭术(PDS)在ⅢC~Ⅳ期卵巢上皮癌患者中的预后价值。方法从美国监测、流行病学和结果数据库(SEER)中纳入诊断时间为2010-01-01-2015-12-31的1950例ⅢC~Ⅳ期卵巢上皮癌患者作为研究对象,随访截止时间为2019-11-30。按照初始治疗模式分为NACT组和PDS组,分析对比2组的临床特征、生存期及预后因素。结果与PDS组比较,患者≥65岁(χ^(2)=7.299,P=0.007)、Ⅳ期(χ^(2)=77.900,P<0.001)、CA125阳性(χ^(2)=13.700,P=0.001)、术后残留病灶>1 cm(χ^(2)=8.600,P=0.013)的比例在NACT组较多,差异有统计学意义。NACT组中位总生存期(OS)为33个月,PDS组中位OS为37个月,2组之间差异无统计学意义(P=0.070)。多因素分析结果显示,年龄(HR=1.328,95%CI为1.188~1.485,P<0.001)、低分化(HR=2.992,95%CI为1.116~8.025,P=0.029)、双侧病灶(HR=1.139,95%CI为1.013~1.281,P=0.030)、分期(HR=1.260,95%CI为1.122~1.415,P<0.001)、残留病灶>1 cm(HR=1.208,95%CI为1.043~1.399,P=0.012)和未知的残留病灶(HR=1.223,95%CI为1.077~1.388,P=0.002)是ⅢC及Ⅳ期卵巢上皮癌患者OS的独立预后因子。NACT与PDS对OS的影响差异无统计学意义(HR=0.987,95%CI为0.870~1.120,P=0.836)。结论NACT和PDS对ⅢC~Ⅳ期卵巢上皮癌患者的预后价值相似,需要结合患者个体情况进行治疗策略的选择。

Objective To compare the prognostic value of neoadjuvant chemotherapy(NACT)and primary debulking surgery(PDS)in patients with stageⅢC-Ⅳovarian epithelial cancer.Methods A total of 1950 patients with stageⅢC-Ⅳepithelial ovarian cancer diagnosed from January 1,2010 to December 31,2015 were included in the U.S.surveillance,epidemiology and results database(SEER).The deadline for follow-up was November 30,2019.According to the initial treatment mode,they were divided into NACT group and PDS group.The clinical characteristics,survival time and prognostic factors of the two groups were analyzed and compared.Results Patients of NACT group in≥65 years old(χ^(2)=7.299,P=0.007),phaseⅣ(χ^(2)=77.900,P<0.001),CA125 positive(χ^(2)=13.700,P=0.001),postoperative residual lesions>1 cm(χ^(2)=8.600,P=0.013)was more than PDS group,the difference was statistically significant.The median overall survival(OS)was 33 months in NACT group and 37 months in PDS group,there was no significant difference between the two groups(P=0.070).Multivariate analysis showed that age(HR=1.328,95%CI was 1.188-1.485,P<0.001),low differentiation(HR=2.992,95%CI was 1.116-8.025,P=0.029),single and bilateral lesions(HR=1.139,95%CI was 1.013-1.281,P=0.030),stage(HR=1.260,95%CI was 1.122-1.415,P<0.001),residual lesions>1 cm(HR=1.208,95%CI was 1.043-1.399,P=0.012)and residual lesions(HR=1.223,95%CI was 1.077-1.388,P=0.002)were independent prognostic factors of OS in patients with stageⅢC andⅣepithelial ovarian cancer.There was no significant difference between NACT and PDS on OS(HR=0.987,95%CI was 0.870-1.120,P=0.836).Conclusions The prognostic values of NACT and PDS are similar.The treatment strategy should be selected according to the individual conditions of patients.