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Overall Survival Following Neoadjuvant Chemotherapy vs Primary Cytoreductive Surgery in Women With Epithelial Ovarian Cancer: Analysis of the National Cancer Database.
新辅助化疗与原发性细胞减灭术治疗上皮性卵巢癌女性的总生存率: 国家癌症数据库的分析。

摘要

Importance:Uncertainty remains about the relative benefits of primary cytoreductive surgery (PCS) vs neoadjuvant chemotherapy (NACT) for advanced-stage epithelial ovarian cancer (EOC).
Objective:To compare overall survival of PCS vs NACT in a large national population of women with advanced-stage EOC.
Design, Setting, and Participants:Retrospective cohort study of women with stage IIIC and IV EOC diagnosed between 2003 and 2011 treated at hospitals across the United States reporting to the National Cancer Data Base. We focused on patients 70 years or younger with a Charlson comorbidity index of 0 who were likely candidates for either treatment.
Exposures:Initial treatment approach of PCS vs NACT, examined using an intent-to-treat analysis.
Main Outcomes and Measures:Overall survival, defined as months from cancer diagnosis to death or date of the last contact. We used propensity score matching to compare similar women who underwent PCS and NACT. The association of treatment approach with overall survival was assessed using the Kaplan-Meier method and the log-rank test. We assessed whether the findings were influenced by differences in the prevalence of an unobserved confounder, such as limited performance status (Eastern Cooperative Oncology Group 1-2), preoperative disease burden, and BRCA status.
Results:Among 22 962 patients (mean [SD] age, 56.12 [9.38] years), 19 836 (86.4%) received PCS and 3126 (13.6%) underwent NACT. We matched 2935 patients treated with NACT with similar patients who received PCS. The median follow-up was 56.5 (95% CI, 54.5-59.2) months in the PCS group and 56.3 (95% CI, 54.5-59.8) months in the NACT group in the propensity-matched cohort. Among propensity score-matched groups, the median overall survival was 37.3 (95% CI, 35.2-38.7) months in the PCS group and 32.1 (95% CI, 30.8-34.1) months in the NACT group (P 

译文

重要性: 对于晚期上皮性卵巢癌 (EOC),原发性细胞减灭术 (PCS) 与新辅助化疗 (NACT) 的相对益处仍然不确定。
目的: 比较具有晚期 EOC 的大量全国女性人群中 PCS 与 NACT 的总体生存率。
设计、背景和参与者: 对 2003年至 2011 间在美国各地医院接受治疗的 IIIC 期和 IV 期 EOC 女性的回顾性队列研究,向国家癌症数据库报告。我们关注的是 70 岁或 70 岁以下的 Charlson 合并症指数为 0 的患者,他们可能是这两种治疗的候选者。
暴露: PCS vs NACT 的初始治疗方法,使用意向治疗分析进行检查。
主要结果和指标: 总生存期,定义为从癌症诊断到死亡的数月或最后一次接触的日期。我们使用倾向评分匹配来比较接受 PCS 和 NACT 的相似女性。使用 Kaplan-Meier 法和 log-rank 检验评估治疗方法与总生存期的相关性。我们评估了这些发现是否受到未观察到的混杂物患病率差异的影响,如有限的表现状态 (东部合作肿瘤组 1-2) 、术前疾病负担和 BRCA 状态。
结果: 在 22962 例患者中 (平均 [SD] 年龄,56.12 [9.38] 岁),19836 例 (86.4%) 接受 PCS 治疗,3126 例 (13.6%) 接受 NACT 治疗。我们将接受 NACT 治疗的 2935 名患者与接受 PCS 治疗的类似患者进行了匹配。PCS 组的中位随访时间为 56.5 (95% CI,54.5-59.2) 个月,56.3 (95% CI,54.5-59.8) 个月倾向匹配队列中 NACT 组的 6 个月。在倾向评分匹配组中,PCS 组的中位总生存期为 37.3 (95% CI,35.2-38.7) 个月和 32.1 (95% CI,30.8-34.1) 个月 NACT 组的月 (p  

cytoreductive surgery

妇产 妇科肿瘤 手术操作
概述  :  

肿瘤减灭术,是指比较大的肿瘤或肿瘤产生一些明显的压迫症状、无法完全切除肿瘤、通过切除部分肿瘤减轻症状,减轻瘤负荷的手术。妇科中常见于卵巢恶性肿瘤,切除卵巢癌之原发灶和转移灶, 使残余肿瘤小于2cm,作为最初的治疗,这一手术的满意程度或彻底性对预后有重要意义。 适应证与禁忌证肿瘤细胞减灭术的适应证是:1)晚期卵巢癌盆腔有大而不规则的肿块,盆腔腹膜有广泛种植转移。2)腹腔内组织器官,包括大网膜,腹膜有种植转移癌灶或脏器有实质性浸润而无手术禁忌证者。肿瘤细胞减灭术的禁忌证是:1)病人因卵

cytoreductive   英 [sɪtəɪ'dʌktɪv] 美 [sɪtəɪ'dʌktɪv]

释    义   [医]细胞减少性的

例    句   Key points of anatomy and the surgical skills in cytoreductive surgery for gynecological tumors. 妇科肿瘤细胞减灭术相关的解剖要点和手术技巧。


surgery    英 [ˈsɜːdʒəri]  美 [ˈsɜːrdʒəri]

释    义   n.外科手术;外科学;应诊时间;诊室;门诊处   复数:surgeries

例    句   Many lives have been saved by surgery. 施行外科手术拯救了许多生命。

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