间歇性肿瘤细胞减灭术治疗晚期卵巢上皮性癌的再评价

Re-evaluation of interval debulking surgery in advanced epithelial ovarian cancer

目的间歇性肿瘤细胞减灭术有可能改善晚期（Ⅲ～Ⅳ期）卵巢上皮性癌（卵巢癌）患者的预后，其确切的应用价值需要再评价。方法采用回顾性病例对照研究的方法分析2000年1月至2009年12月间136例ⅢC～Ⅳ期卵巢癌、原发性腹膜癌、原发性输卵管癌患者的资料，A组（65例）初次手术即获得满意的肿瘤细胞减灭术；B组（41例）初次肿瘤细胞减灭术不满意，术后单纯化疗；C组（30例）初次肿瘤细胞减灭术不满意，经3—4个疗程化疗后行间歇性肿瘤细胞减灭术。比较3组患者的临床特征、手术情况及生存结果。结果136例患者初次肿瘤细胞减灭术的满意率为47．8％（65／136）。C组最终有23例（77％，23／30）达到了满意的肿瘤细胞减灭术。C组术中出血量、术中损伤及术后并发症发生率与B组比较，差异均无统计学意义（P均〉0．05）。A组的无进展生存时间（PFS）为26个月，预后最好。C、B两组总生存时间（OS，分别为40、31个月）及PFS（分别为24、13个月）分别比较，差异均无统计学意义（P=0．254、0．289）。C组中无肉眼残留病灶患者的PFS（27个月）与A组比较，差异无统计学意义（P=0．730），但OS仍比A组差（P=0．010）。结论间歇性肿瘤细胞减灭术不能改善远期预后，但达到无肉眼残留的患者能改善其术后PFS。该手术本身安全、可耐受，可作为基层医院无法达到满意肿瘤细胞减灭术患者的一个补充治疗选择。

Objective Previous study showed that interval debulking surgery （IDS） may improve the survival of patients with advanced epithelial ovarian cancer （EOC）. The precise significance of IDS needs to be evaluated. Methods Totally 136 consecutive patients with stage m c or IV EOC （including primary peritoneal carcinoma and primary fallopian tube carcinoma） who completed primary debulking surgery （PDS） and platinum-based chemotherapy were enrolled from January 2000 to December 2009 in a retrospective cohort study. The study group was divided into three groups：65 cases underwent optimal PDS （Group A）, 41 cases received chemotherapy alone after suboptimal PDS （Group B）, and 30 patients underwent IDS after suboptimal PDS （ Group C）. All patients received six to eight courses of platinum-based combination chemotherapy （paclitaxel plus carboplatin/cisplatin, cyclophosphamide plus epimbicin and cisplatin）. Patients＇ clinical characteristics, perioperative situation and prognosis were compared. Results Sixty-five cases （47.8% , 65/136） from 136 patients achieved optimal PDS. For Group C, 77% （23/30） patients obtained optimal debulking surgery after IDS. Intraoperative injury rates were similar between Group B and Group C （P 〉 0. 05）. Mild perioperative complications rate was also similar （P 〉0. 05）. Median progression-free survival （PFS） of Group A was 26 months. Median overall survival （OS） of Group B and Group C were 31 months and 40 months, respectively （P = 0. 254）. Median PFS of Group B and Group C were 13 months and 24 months, respectively （P =0. 289）. Although when it came to 20 months after PDS, patients who underwent IDS had a significantly lower progressive disease （PD） rate （Group B 33% versus Group C 61%, P =0. 046）, it still showed that there was no significant difference in either OS or PFS of these two groups. Those patients in Group C who obtained no visible residual got similar PFS （27 months）comparing to Group A （26 months, P = 0. 730）, but OS was still shorter （P = 0. 010）. Conclusions For advanced EOC patients, IDS has little effect on improving survival. While it is safe and acceptable, also may prolong PFS in those patients who got no visible residual after IDS. The results suggest that IDS might be used as an alternative treatment for advanced EOC patients who cannot obtain optimal PDS in certain local hospitals.