Background:The optimal timing of cytoreductive surgery for advanced high-grade serous carcinoma (HGSC) remains a critical unmet question in the modern era of platinum-based chemotherapy and PARP inhibitor (PARPi) maintenance. To address this gap, we compared outcomes following primary debulking surgery (PDS) versus interval debulking surgery (IDS) in a uniformly treated, contemporary cohort.Methods:Patients with FIGO stage IIIB–IVB HGSC treated between 2019 and 2023 were retrospectively analyzed. Baseline tumor burden was assessed using detailed radiologic and laparoscopic evaluations, including both presurgical and intraoperative assessments. Progression-free survival (PFS) and overall survival (OS) were examined using multivariable Cox proportional hazards models and reported as adjusted hazard ratios (aHRs). Subgroup analyses were rigorously conducted according to residual disease status andBRCAmutation status.Results:Among 221 patients (PDS,n= 60; IDS,n= 151), the median follow-up was 40 months. In the overall cohort, adjusted PFS and OS did not differ significantly between the PDS and IDS groups (PFS: aHR, 1.15; 95%CI, 0.67–1.98; OS: aHR, 1.24; 95%CI, 0.54–2.83). Outcomes were comparable among patients achieving R0 resection. Notably,BRCA-mutated patients demonstrated a substantial survival advantage with PDS (BRCA-mutated PFS: aHR, 3.34; 95%CI, 1.06–16.67; OS: aHR, 6.07; 95%CI, 2.13–∞), whereasBRCAwild-type patients showed no significant difference between surgical strategies.Conclusions:The findings suggest that BRCA-mutated patients may derive a survival benefit from PDS, whereas surgical timing had a limited impact on BRCA wild-type disease. This result underscores the importance of integrating molecular profiling, particularlyBRCAmutation status, with surgical assessment to guide optimal and personalized treatment strategies in the PARPi era.
背景：在以铂类化疗和PARP抑制剂（PARPi）维持治疗为特征的现代医疗背景下，晚期高级别浆液性癌（HGSC）行肿瘤细胞减灭术的最佳时机仍是一个亟待解决的关键问题。为探讨这一问题，我们在一个经统一治疗的当代队列中，比较了初始肿瘤细胞减灭术（PDS）与中间型肿瘤细胞减灭术（IDS）的结局。
方法：回顾性分析了2019年至2023年间治疗的FIGO IIIB–IVB期HGSC患者。通过详细的影像学及腹腔镜评估（包括术前及术中评估）来评估基线肿瘤负荷。采用多变量Cox比例风险模型评估无进展生存期（PFS）和总生存期（OS），并报告校正后的风险比（aHR）。根据残留病灶状态和BRCA突变状态进行了严格的亚组分析。
结果：在221例患者（PDS组，n=60；IDS组，n=151）中，中位随访时间为40个月。在整个队列中，PDS组与IDS组校正后的PFS和OS无显著差异（PFS：aHR, 1.15；95% CI, 0.67–1.98；OS：aHR, 1.24；95% CI, 0.54–2.83）。在达到R0切除的患者中，结局相当。值得注意的是，BRCA突变患者在接受PDS后显示出显著的生存优势（BRCA突变者PFS：aHR, 3.34；95% CI, 1.06–16.67；OS：aHR, 6.07；95% CI, 2.13–∞），而BRCA野生型患者在不同手术策略间未显示显著差异。
结论：研究结果表明，BRCA突变患者可能从PDS中获得生存获益，而手术时机对BRCA野生型疾病的影响有限。这一结果强调了在PARPi时代，整合分子特征（尤其是BRCA突变状态）与手术评估对于指导优化和个体化治疗策略的重要性。
Surgical Timing and Survival in Advanced High-Grade Serous Ovarian Cancer in the PARP Inhibitor Era
肿瘤(癌症)患者之家