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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

肿瘤 肿瘤切除 治疗方法
概述  :  

最早的再次肿瘤细胞减灭术由Berek等于1980年提出,此后逐渐成为研究热点。肿瘤细胞减灭术是一种肿瘤治疗方法,肿瘤细胞减灭术就是减灭肿瘤细胞的数量,是指针对一些比较大的或者是会出现压迫症状,但是却无法将肿瘤完全切除的患者,通过将肿瘤部分切除来缓解症状并减轻肿瘤负担的手术。该方法并不适用于所有肿瘤,而是通常只适用于晚期卵巢癌并且盆腔中有大肿块和广泛移植趋势的患者。在卵巢癌患者中,肿瘤细胞减灭术是指对于晚期卵巢癌患者以最大限度地切除肿瘤为目的的手术措施,包括初次(primary cytored

Cytoreductive 

释    义   adj. 细胞减少性的

例    句   Methods:50 patients with mean platinum free interval (PFI) of 6.6 months (0.5~36 months) received secondary cytoreductive surgery followed by second line chemotherapy. 方法:50例平均停用铂类药物化疗时间(PFI)为6 .6(0 .5-36)个月的卵巢癌患者接受二次肿瘤细胞减灭术及术后二线化疗。

 

Surgery   英 /'sɜːdʒ(ə)rɪ/   美 /'sɝdʒəri/

释    义   n. 外科;外科手术;手术室;诊疗室;复数 surgeries

同根词   surgical adj. 外科的;手术上的;surgically adv. 如外科手术般地;surgeon n. 外科医生;surgical n. 外科手术;外科病房

例    句   However, they almost always respond to the combination of antibiotics and surgery. 然而,他们几乎总是对抗生素和外科手术的结合产生反应。

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