Patients with stage IV epithelial ovarian cancer: understanding the determinants of survival

Journal of Translational Medicine

For the Groupe de Recherche FRANCOGYN¹  Vincent Lavoue²  Cyrille Huchon³  Sofiane Bendifallah⁴  Marcos Ballester⁴  Emile Daraï⁴  Bassam Haddad⁵  Yohann Dabi⁵  Cyril Touboul⁵  Pierre Collinet⁶  Lobna Ouldamer⁷  Alexandre Bricou⁸ 

[1] ;CRLCC Eugène-Marquis, Department of Gynecology, CHU de Rennes, Université de Rennes 1;Department of Gynecology and Obstetrics, Intercommunal Hospital Centre of Poissy – Saint Germain – en – Laye;Department of Gynecology and Obstetrics, Tenon University Hospital, Assistance Publique, Hôpitaux de Paris (AP-HP) des, University Pierre and Marie Curie, Paris 6, Institut Universitaire de Cancérologie (IUC);Department of Obstetrics and Gynecology, Centre Hospitalier Intercommunal, Faculté de médecine de Créteil UPEC-Paris XII;Department of Obstetrics and Gynecology, Centre Hospitalier Régional Universitaire;Department of Obstetrics and Gynecology, Centre hospitalier régional universitaire de Tours, hôpital Bretonneau;Department of Obstetrics and Gynecology, Jean-Verdier University Hospital, Assistance Publique, Hôpitaux de Paris (AP-HP) des;

关键词: Ovarian cancer;    Stage IV;    Debulking surgery;    Chemotherapy;    Prognostic factors;    Post-operative residual disease;   

DOI  :  10.1186/s12967-020-02295-y

来源: DOAJ

【 摘 要 】

Abstract Background The most appropriate management for patients with stage IV ovarian cancer remains unclear. Our objective was to understand the main determinants associated with survival and to discuss best surgical management. Methods Data of 1038 patients with confirmed ovarian cancer treated between 1996 and 2016 were extracted from maintained databases of 7 French referral gynecologic oncology institutions. Patients with stage IV diseases were selected for further analysis. The Kaplan–Meier method was used to estimate the survival distribution. A Cox proportional hazards model including all the parameters statistically significant in univariable analysis, was used to account for the influence of multiple variables. Results Two hundred and eight patients met our inclusion criteria: 65 (31.3%) never underwent debulking surgery, 52 (25%) underwent primary debulking surgery (PDS) and 91 (43.8%) neoadjuvant chemotherapy and interval debulking surgery (NACT-IDS). Patients not operated had a significantly worse overall survival than patients that underwent PDS or NACT–IDS (p < 0.001). In multivariable analysis, three factors were independent predictors of survival: upfront surgery (HR 0.32 95% CI 0.14–0.71, p = 0.005), postoperative residual disease = 0 (HR 0.37 95% CI 0.18–0.75, p = 0.006) and association of Carboplatin and Paclitaxel regimen (HR 0.45 95% CI 0.25–0.80, p = 0.007). Conclusions Presence of distant metastases should not refrain surgeons from performing radical procedures, whenever the patient is able to tolerate. Maximal surgical efforts should be done to minimize residual disease as it is the main determinant of survival.

【 授权许可】

Unknown