Given the rising use of neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) in advanced epithelial ovarian cancer (EOC), we sought to assess practice trends in overall survival (OS), complete gross resection (R0), and postoperative mortality following debulking surgery. The National Cancer Database (NCDB) was used to identify 34,982 stage IIIC and IV EOC patients between 2010 and 2017 who underwent surgery. Annual proportions of patients receiving IDS and PDS were calculated. Median OS was estimated using the Kaplan–Meier method. Joinpoint models were fitted to evaluate surgical trends. Statistics were performed using SPSS and Joinpoint. Of 34,982 patients, 10,460 (29.9%) underwent IDS. IDS patients were older, more likely to have stage IV disease, and more likely to be non-White. Median OS was higher in the PDS group (54 vs. 38.8 months,p< 0.001). Postoperative 90-day mortality was lower in the PDS group (1.7% vs. 2.4%,p< 0.001), though IDS patients had a lower 30-day readmission rate (6.2% vs. 3.1%,p< 0.001). IDS patients were less likely to undergo extensive surgery (27.4% vs. 36.7%,p< 0.001) and more likely to achieve R0 resection (42% vs. 38.6%,p< 0.001). The IDS rate increased from 18.9% to 40.6% (annual percentage change (APC): 11.8%,p< 0.05) from 2010 to 2017. Median OS improved from 46.6 to 51 months (APC: 1.9%,p< 0.05), driven by the PDS cohort. The R0 resection rate rose from 34.8 to 41% (APC: 2.65%,p< 0.01), driven by the PDS cohort (APC: 2.83%,p< 0.01). Postoperative 90-day mortality decreased from 2.4% to 1.5% (APC: −4.64%,p< 0.05), due to a reduction in PDS patients (APC: −6.83%,p< 0.05). There was no change in the rate of extensive surgery over time. In conclusion, from 2010 to 2017, increased triage of patients to NACT was accompanied by a higher R0 resection rate and reduced postoperative mortality in PDS patients, with no observed detriment to OS. This data suggests improvement in case selection between IDS and PDS.
鉴于新辅助化疗（NACT）继以间歇性肿瘤细胞减灭术（IDS）在晚期上皮性卵巢癌（EOC）中的应用日益增多，本研究旨在评估肿瘤减灭术后总生存期（OS）、肉眼完全切除（R0）及术后死亡率的实践趋势。通过美国国家癌症数据库（NCDB）识别2010年至2017年间接受手术的34,982例IIIC期和IV期EOC患者。计算每年接受IDS与初次肿瘤细胞减灭术（PDS）的患者比例，采用Kaplan-Meier法评估中位OS，并运用Joinpoint模型分析手术趋势变化。统计分析使用SPSS和Joinpoint软件完成。 在34,982例患者中，10,460例（29.9%）接受了IDS治疗。IDS患者年龄更大、IV期比例更高、非白人种族占比更高。PDS组中位OS显著更长（54个月 vs. 38.8个月，p<0.001）。虽然IDS组30天再入院率更低（3.1% vs. 6.2%，p<0.001），但PDS组术后90天死亡率更低（1.7% vs. 2.4%，p<0.001）。IDS组接受扩大手术的比例更低（27.4% vs. 36.7%，p<0.001），但R0切除率更高（42% vs. 38.6%，p<0.001）。 2010年至2017年间，IDS实施率从18.9%上升至40.6%（年度变化百分比[APC]：11.8%，p<0.05）。中位OS从46.6个月提升至51个月（APC：1.9%，p<0.05），这一改善主要由PDS组驱动。R0切除率从34.8%上升至41%（APC：2.65%，p<0.01），同样主要得益于PDS组的提升（APC：2.83%，p<0.01）。术后90天死亡率从2.4%降至1.5%（APC：-4.64%，p<0.05），主要源于PDS组死亡率的下降（APC：-6.83%，p<0.05）。扩大手术率在此期间未发生显著变化。 综上所述，2010年至2017年间，随着更多患者被分诊至NACT治疗，PDS患者的R0切除率提高且术后死亡率降低，而总生存期未见受损。这些数据提示IDS与PDS之间的病例选择策略取得了优化改进。
肿瘤(癌症)患者之家