دورية أكاديمية

Interval debulking surgery is not worth the wait: a National Cancer Database study comparing primary cytoreductive surgery versus neoadjuvant chemotherapy.

التفاصيل البيبلوغرافية
العنوان: Interval debulking surgery is not worth the wait: a National Cancer Database study comparing primary cytoreductive surgery versus neoadjuvant chemotherapy.
المؤلفون: Lyons YA; OBGYN, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA yasmin-lyons@uiowa.edu., Reyes HD; University at Buffalo - The State University of New York, Buffalo, New York, USA., McDonald ME; University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA., Newtson A; University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA., Devor E; University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA., Bender DP; University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA., Goodheart MJ; University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA., Gonzalez Bosquet J; University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
المصدر: International journal of gynecological cancer : official journal of the International Gynecological Cancer Society [Int J Gynecol Cancer] 2020 Jun; Vol. 30 (6), pp. 845-852. Date of Electronic Publication: 2020 Apr 26.
نوع المنشور: Comparative Study; Journal Article; Research Support, N.I.H., Extramural
اللغة: English
بيانات الدورية: Publisher: BMJ Country of Publication: England NLM ID: 9111626 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1525-1438 (Electronic) Linking ISSN: 1048891X NLM ISO Abbreviation: Int J Gynecol Cancer Subsets: MEDLINE
أسماء مطبوعة: Publication: 2019- : [London] : BMJ
Original Publication: Cambridge, MA, USA : Blackwell Scientific Publications, c1991-
مواضيع طبية MeSH: Cytoreduction Surgical Procedures* , Neoadjuvant Therapy*, Carcinoma, Ovarian Epithelial/*surgery , Ovarian Neoplasms/*surgery, Adolescent ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Ovarian Epithelial/drug therapy ; Carcinoma, Ovarian Epithelial/mortality ; Female ; Humans ; Middle Aged ; Ovarian Neoplasms/drug therapy ; Ovarian Neoplasms/mortality ; Retrospective Studies ; Survival Analysis ; United States/epidemiology ; Young Adult
مستخلص: Objective: In previous studies, neoadjuvant chemotherapy followed by interval debulking surgery was not inferior to primary cytoreductive surgery as initial treatment for advanced epithelial ovarian cancer. Our study aimed to compare surgical and survival outcomes between the two treatments in a large national database.
Methods: Data were extracted from the National Cancer Database from January 2004 to December 2015. Patients with FIGO (International Federation of Gynecologists and Obstetricians) stage III-IV epithelial ovarian cancer and known sequence of treatment were included: primary cytoreductive (surgery=26 717 and neoadjuvant chemotherapy=9885). Tubal and primary peritoneal cancer diagnostic codes were not included. Residual disease after treatment was defined based on recorded data: R0 defined as microscopic or no residual disease; R1 defined as macroscopic residual disease. Multivariate Cox proportional HR was used for survival analysis. Multivariate logistic regression analysis was utilized to compare mortality between groups. Outcomes were adjusted for significant covariates. Validation was performed using propensity score matching of significant covariates.
Results: A total of 36 602 patients were included in the analysis. Patients who underwent primary cytoreductive surgery had better survival than those treated with neoadjuvant chemotherapy followed by interval surgery, after adjusting for age, co-morbidities, stage, and residual disease (p<0.001). Primary cytoreductive surgery patients with R0 disease had best median survival (62.6 months, 95% CI 60.5-64.5). Neoadjuvant chemotherapy patients with R1 disease had worst median survival (29.5 months, 95% CI 28.4-31.9). There were small survival differences between primary cytoreductive surgery with R1 (38.9 months) and neoadjuvant chemotherapy with R0 (41.8 months) (HR 0.93, 95% CI 0.87 to 1.0), after adjusting for age, co-morbidities, grade, histology, and stage. Neoadjuvant chemotherapy had 3.5 times higher 30-day mortality after surgery than primary cytoreductive surgery (95% CI 2.46 to 5.64). The 90-day mortality was higher for neoadjuvant chemotherapy in multivariate analysis (HR 1.31, 95% CI 1.06 to 1.61) but similar to primary cytoreductive surgery after excluding high-risk patients.
Conclusions: Most patients with advanced epithelial ovarian cancer may benefit from primary cytoreductive surgery. Patients treated with neoadjuvant chemotherapy should be those with co-morbidities unfit for surgery.
Competing Interests: Competing interests: None declared.
(© IGCS and ESGO 2020. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ.)
References: Lancet. 2015 Jul 18;386(9990):249-57. (PMID: 26002111)
N Engl J Med. 2010 Sep 2;363(10):943-53. (PMID: 20818904)
Obstet Gynecol. 2011 Sep;118(3):537-47. (PMID: 21860281)
Gynecol Oncol. 2007 Oct;107(1):99-106. (PMID: 17602726)
PLoS One. 2017 Oct 23;12(10):e0186725. (PMID: 29059209)
Int J Gynecol Cancer. 2019 Oct;29(8):1327-1331. (PMID: 31420412)
Cochrane Database Syst Rev. 2014 Feb 21;(2):CD009786. (PMID: 24563459)
BMJ. 2018 Jan 3;360:j5463. (PMID: 29298771)
J Clin Oncol. 2019 Sep 20;37(27):2398-2405. (PMID: 31403864)
Gynecol Oncol. 2011 Jan;120(1):23-8. (PMID: 20933255)
Int J Gynecol Cancer. 2015 Mar;25(3):407-15. (PMID: 25695545)
J Clin Oncol. 2017 Feb 20;35(6):613-621. (PMID: 28029317)
J Natl Cancer Inst. 2014 Apr 03;106(5):. (PMID: 24700803)
Gynecol Oncol. 2013 Feb;128(2):229-32. (PMID: 23142076)
معلومات مُعتمدة: P30 CA008748 United States CA NCI NIH HHS
فهرسة مساهمة: Keywords: ovarian cancer; ovarian diseases; ovarian neoplasms; ovary
تواريخ الأحداث: Date Created: 20200429 Date Completed: 20210614 Latest Revision: 20210614
رمز التحديث: 20231215
مُعرف محوري في PubMed: PMC7362882
DOI: 10.1136/ijgc-2019-001124
PMID: 32341114
قاعدة البيانات: MEDLINE
الوصف
تدمد:1525-1438
DOI:10.1136/ijgc-2019-001124