内容紹介
Comparison between Primary Debulking Surgery and Neo-Adjuvant Chemotherapy Followed by Interval Debulking Surgery for Patients with Stage Ⅲ-Ⅳ Ovarian Cancer
Summary
The current standard treatment for advanced ovarian cancer is primary debulking surgery(PDS). We may expect a good prognosis if complete debulking(no visible residual tumor)is possible. However, if complete surgery is not possible owing to the location of the tumor or poor performance status, neo-adjuvant chemotherapy(NAC)could be an alternative option. Interval debulking surgery(IDS)can be planned after NAC to try and achieve complete debulking surgery. We reviewed stage Ⅲ and Ⅳ epithelial ovarian cancers treated at Kansai Rosai Hospital between January 2012 and January 2016. Fifty-one cases(PDS: 22 cases, NAC-IDS: 29 cases)were enrolled in our analysis. Progression-free survival(PFS), overall survival(OS), the successful complete surgery rate, and the contents and complications of the surgery were compared between the PDS and NAC-IDS groups. There was no significant difference in PFS and OS between the 2 groups(PFS: p=0.467, OS: p=0.685). Blood loss was larger in the PDS group(p=0.013). Patients in the NAC-IDS group were likely to be able to eventually achieve complete surgery(p=0.016). NAC followed by IDS is one of the effective treatment options for advanced ovarian cancers.
要旨
進行卵巣癌に対する現在の標準治療はprimary debulking surgery(PDS)であり,肉眼的残存腫瘍なしのcomplete surgeryが達成できれば予後の改善が期待できる。ただし,病巣の存在部位や患者の全身状態を加味してPDS時にcomplete surgeryが困難と予想される例には,neo-adjuvant chemotherapy(NAC)を行うことも選択肢となる。NAC後にinterval debulking surgery(IDS)を行い,complete surgeryをめざすこととなる。当科で2012年1月～2016年1月までに初回治療を行った卵巣癌Ⅲ～Ⅳ期の51例(PDS群: 22例,NAC-IDS群: 29例)を対象とし,progression free survival(PFS),overall survival(OS),complete surgery達成率,手術内容や合併症を後方視的に検討した。NAC-IDS群はPDS群と比較して,PFS,OSに有意差を認めなかった(PFS: p=0.467,OS: p=0.685)。手術出血量がPDS群で有意に多く(p=0.013),complete surgery達成率はNAC-IDS群で有意に高かった(p=0.016)。卵巣癌Ⅲ～Ⅳ期に対し,患者の状態を勘案したNAC-IDSは許容される治療選択肢である。
目次
Summary
The current standard treatment for advanced ovarian cancer is primary debulking surgery(PDS). We may expect a good prognosis if complete debulking(no visible residual tumor)is possible. However, if complete surgery is not possible owing to the location of the tumor or poor performance status, neo-adjuvant chemotherapy(NAC)could be an alternative option. Interval debulking surgery(IDS)can be planned after NAC to try and achieve complete debulking surgery. We reviewed stage Ⅲ and Ⅳ epithelial ovarian cancers treated at Kansai Rosai Hospital between January 2012 and January 2016. Fifty-one cases(PDS: 22 cases, NAC-IDS: 29 cases)were enrolled in our analysis. Progression-free survival(PFS), overall survival(OS), the successful complete surgery rate, and the contents and complications of the surgery were compared between the PDS and NAC-IDS groups. There was no significant difference in PFS and OS between the 2 groups(PFS: p=0.467, OS: p=0.685). Blood loss was larger in the PDS group(p=0.013). Patients in the NAC-IDS group were likely to be able to eventually achieve complete surgery(p=0.016). NAC followed by IDS is one of the effective treatment options for advanced ovarian cancers.
要旨
進行卵巣癌に対する現在の標準治療はprimary debulking surgery(PDS)であり,肉眼的残存腫瘍なしのcomplete surgeryが達成できれば予後の改善が期待できる。ただし,病巣の存在部位や患者の全身状態を加味してPDS時にcomplete surgeryが困難と予想される例には,neo-adjuvant chemotherapy(NAC)を行うことも選択肢となる。NAC後にinterval debulking surgery(IDS)を行い,complete surgeryをめざすこととなる。当科で2012年1月～2016年1月までに初回治療を行った卵巣癌Ⅲ～Ⅳ期の51例(PDS群: 22例,NAC-IDS群: 29例)を対象とし,progression free survival(PFS),overall survival(OS),complete surgery達成率,手術内容や合併症を後方視的に検討した。NAC-IDS群はPDS群と比較して,PFS,OSに有意差を認めなかった(PFS: p=0.467,OS: p=0.685)。手術出血量がPDS群で有意に多く(p=0.013),complete surgery達成率はNAC-IDS群で有意に高かった(p=0.016)。卵巣癌Ⅲ～Ⅳ期に対し,患者の状態を勘案したNAC-IDSは許容される治療選択肢である。