初次肿瘤细胞减灭术与中间性肿瘤细胞减灭术对晚期卵巢癌患者远期生存的影响真实世界临床研究

Real-World Clinical Study on the Impact of Primary Debulking Surgery and Interval Debulking Surgery on the Long-Term Survival of Patients with Advanced Ovarian Cancer

目的:比较初次肿瘤细胞减灭术(PDS)与中间性肿瘤细胞减灭术(IDS)对晚期卵巢癌患者远期生存的影响。方法:收集自2018年1月至2018年6月于中国科学技术大学附属第一医院妇瘤科手术(PDS/IDS)的晚期上皮性卵巢癌(III-IVB期)患者,从其生存期(OS)、严重手术并发症发生率等方面对比两种术式。采用Kaplan-Meier法分析生存曲线,采用log-rank检验比较生存差异,采用Cox比例风险回归模型分析影响生存的危险因素。结果:共纳入76例患者,其中IDS组24例,PDS组52例。两组患者在年龄、营养评分、术前血红蛋白(Hb)水平、组织病理学类型、临床分期等方面无统计学差异(P>0.05)。IDS组术中出血量显著低于PDS组(1045.83±981.91 mL vs 1628.85±1168.72 mL,P<0.01)。IDS组严重手术并发症发生率显著低于PDS组(12.5%vs 36.5%,P<0.05)。随访期间,IDS组共9例死亡,PDS组共16例死亡。IDS组的中位OS为47.0个月,PDS组的中位OS为38.0个月,两组间的OS差异无统计学意义(P=0.17)。多因素Cox回归分析显示,术中出血量(HR=1.001,95%CI=1.000-1.002,P=0.03)和严重手术并发症(HR=2.345,95%CI=1.123-4.902,P=0.02)是影响OS的独立危险因素,而术式(PDS/IDS)不是影响OS的独立危险因素(HR=0.667,95%CI=0.302-1.473,P=0.32)。结论:对于晚期卵巢癌患者,IDS与PDS相比,可以减少术中出血量和严重手术并发症的发生率,但对远期生存无显著影响。术中出血量和严重手术并发症是影响远期生存的独立危险因素,应尽量避免。

Objective:To compare the impact of primary debulking surgery(PDS)and interval debulking surgery(IDS)on the long-term survival of patients with advanced ovarian cancer.Methods:Patients with advanced epithelial ovarian cancer(stage III-IVB)who underwent surgery(PDS/IDS)in the Gynecology Department of The First Affiliated Hospital of University of USTC from January 2018 to June 2018 were collected.The two types of surgery were compared in terms of survival time(OS)and incidence of serious surgical complications.Kaplan-Meier method was used to analyze the survival curve,log-rank test was used to compare the survival differences,and Cox proportional hazards regression model was used to analyze the risk factors affecting survival.Results:A total of 76 patients were included,including 24 cases in the IDS group,and 52 cases in the PDS group.There were no statistically significant differences between the two groups in terms of age,nutritional score,preoperative hemoglobin(Hb)levels,histopathological types,clinical stages,etc(P>0.05).The intraoperative bleeding volume in the IDS group was significantly lower than that in the PDS group(1045.83±981.91 mL vs 1628.85±1168.72 mL,P<0.01).The incidence of serious surgical complications in the IDS group was significantly lower than that in the PDS group(12.5%vs 36.5%,P<0.05).During follow-up,there were 9 deaths in the IDS group,and 16 deaths in the PDS group.The median OS in the IDS group was 47.0 months,and the median OS in the PDS group was 38.0 months,and there was no significant difference in OS between the two groups(P=0.17).Multivariate Cox regression analysis showed that intraoperative bleeding volume(HR=1.001,95%CI=1.000-1.002,P=0.03)and severe surgical complications(HR=2.345,95%CI=1.123-4.902,P=0.02)were independent risk factors affecting OS,while the operation type(PDS/IDS)was not an independent risk factor affecting OS(HR=0.667,95%CI=0.302-1.473,P=0.32).Conclusion:In patients with advanced ovarian cancer,IDS compared with PDS can reduce intraoperative bleeding volume and the incidence of serious surgical complications,but has no significant effect on long-term survival.Intraoperative bleeding volume and severe surgical complications are independent risk factors for long-term survival,and should be avoided.