国际妇产科联盟Ⅳ期卵巢高级别浆液性癌患者远期生存情况及相关影响因素分析

Long-term outcomes of patients with International Federation of Gynecology and Obstetrics stageⅣovarian high-grade serous carcinoma and correlated influencing factors

目的探讨国际妇产科联盟(FIGO)Ⅳ期卵巢高级别浆液性癌患者的远期生存情况和相关影响因素。方法回顾性分析2010年1月至2020年12月于北京大学肿瘤医院接受初治Ⅳ期卵巢高级别浆液性癌患者的临床资料。根据治疗方式不同,将患者分为初始肿瘤细胞减灭术(PDS)组、中间型肿瘤细胞减灭术(IDS)组和单纯化疗组。分析患者的总生存期以及相关影响因素。结果本研究共纳入125例患者,其中PDS组21例、IDS组91例、单纯化疗组13例。3组年龄、糖类抗原125水平比较差异均有统计学意义(均P<0.05);PDS组与IDS组手术复杂性评分、上腹部手术比例比较差异均有统计学意义(均P<0.05)。PDS组中位总生存期70个月、IDS组中位总生存期56个月、单纯化疗组中位总生存期25个月,3组总生存期比较差异有统计学意义(P<0.001)。基于FIGO分期的分层分析结果显示,ⅣA期患者中位总生存期短于ⅣB期患者(49个月比59个月,P=0.013)。多因素Cox分析结果显示,初始治疗方式、应用聚腺苷二磷酸核糖聚合酶(PARP)抑制剂及术后肿瘤残留是Ⅳ期卵巢高级别浆液性癌患者总生存期的独立影响因素(均P<0.05)。结论肿瘤细胞减灭术可改善Ⅳ期卵巢高级别浆液性癌患者的预后,初始治疗方式、应用PARP抑制剂及术后肿瘤残留是总生存期的独立影响因素。

Objective To investigate long-term outcomes of patients with International Federation of Gynecology and Obstetrics(FIGO)stageⅣovarian high-grade serous carcinoma(HGSOC)and correlated influencing factors.Methods Clinical data of patients with FIGO stageⅣHGSOC admitted to Beijing Cancer Hospital from January 2010 to December 2020 were collected retrospectively.Patients were divided into primary debulking surgery(PDS)group,interval debulking surgery(IDS)group,and chemotherapy alone group according to the treatment approaches.The overall survival and correlated influencing factors were analyzed.Results Totally 125 patients were enrolled in this study,including 21 cases in the PDS group,91 cases in the IDS group and 13 cases in the chemotherapy alone group.There were significant differences in age and carbohydrate antigens level among the three groups(both P<0.05).There were significant differences in surgical complexity score and the proportion of upper abdominal surgery between the PDS group and the IDS group(both P<0.05).The medium overall survival in the PDS group,IDS group and chemotherapy alone group was 70,56 and 25 months,respectively,and the difference was statistically significant(P<0.001).Stratified analysis based on FIGO staging showed that the medium overall survival of patients with stageⅣA was shorter than patients with stageⅣB(49 months vs 59 months,P=0.013).Multivariate Cox analysis showed that initial treatment,application of polyadenosine diphosphate ridose polymerase(PARP)inhibitors,and postoperative tumor remnant were independent factors influencing the overall survival of patients with stageⅣovarian HGSOC(all P<0.05).Conclusions Debulking surgery improves outcomes for patients with stageⅣovarian HGSOC,and the initial treatment,application of PARP inhibitors,and postoperative tumor remnant are independent factors influencing the overall survival.