Abdominopelvic cytoreduction rates and recurrence sites in stage IV ovarian cancer: Is there a case for thoracic cytoreduction?

作者：Perri Tamar^*; Ben Baruch Gilad; Kalfon Sarit; Beiner Mario E; Helpman Limor; Hogen Liat Ben David; Shapira Frommer Ronnie; Korach Jacob

来源：Gynecologic Oncology, 2013, 131(1): 27-31.

DOI：10.1016/j.ygyno.2013.07.093

• Ovarian cancer
• Advanced
• Thorax
• Cytoreduction
• Recurrence site

Objective. We report the rates of optimal abdaminopelvic cytoreduction and the sites of recurrence in stage IV ovarian cancer patients, with particular attention to the potential impact of thoracic cytoreduction on treatment results in patients with intra-thoracic spread.
Methods. A historic cohort study of all stage IV ovarian cancer patients diagnosed between 1994 and 2010 and underwent abdominopelvic cytoreductive surgery. Controls were stage Illc patients. Statistical analyses included chi(2) test, Cox proportional hazards regression models and Kaplan-Meier curves with log-rank tests.
Results. Group 1 included 76 stage IV patients, 55% with thoracic spread. Group 2 included 142 stage IIIc patients. Age, histology, primary peritoneal tumor and ascites rates were similar for the two groups. Respective rates of optimal abdominopelvic cytoreduction were 68% vs. 83.5% (p < 0.05), median time to progression 5.3 vs. 12.3 months (p < 0.01) and overall survival 27.2 vs. 46.1 months (p < 0.01). Optimal cytoreduction and survival rates were similar for all group 1 patients regardless of spread location. Sites of recurrence in stage IV were abdomen (593%), thorax (6.8%), both (28.8%) or other (5.1%). The four patients with thoracic recurrence alone were all initially diagnosed with malignant pleural effusion. Three of them developed abdominal recurrence within 1.5 6 months.
Conclusions. Optimal abdominopelvic cytoreduction was achievable in stage IV patients, although in significantly fewer patients than in stage IIIc. Sites of recurrence were rarely thorax alone, implying that thoracic debulldng is likely to change the course of disease in only few patients and thus should be carefully individualized.

• 出版日期2013-10