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- 저자 : Vance A. Broach (검색결과 1 건)
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Ying L. Liu,Olga T. Filippova,Qin Zhou,Alexia Iasonos,Dennis S. Chi,Oliver Zivanovic,Yukio Sonoda,Ginger J. Gardner,Vance A. Broach,Roisin E. OCearbhaill,Jason A. Konner,Carol Aghajanian,Kara Long Roc 대한부인종양학회 2020 Journal of Gynecologic Oncology Vol.31 No.1
Objective: Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS)confers similar outcomes as primary debulking surgery and chemotherapy. Little is knownabout patients who receive NACT but do not undergo debulking surgery. Our aim was tocharacterize these patients. Methods: We prospectively identified patients with newly diagnosed stage III/IV ovariancancer treated with NACT from 7/1/15–12/1/17. Fisher exact and Wilcoxon rank-sum tests wereused to compare clinical characteristics by surgical status. The Kaplan-Meier method wasused to estimate survival outcomes. Log-rank test and Cox proportional hazards model wereapplied to assess the relationship of covariates to outcome, and time-dependent covariateswere applied to variables collected after diagnosis. Results: Of 224 women who received NACT, 162 (72%) underwent IDS and 62 (28%) didnot undergo surgery. The non-surgical group was older (p<0.001), had higher Charlsoncomorbidity index (CCI; p<0.001), lower albumin levels (p=0.007), lower Karnofskyperformance scores (p<0.001), and were more likely to have dose reductions in NACT(p<0.001). Reasons for no surgery included poor response to NACT (39%), death (15%),comorbidities (24%), patient preference (16%), and loss to follow-up (6%). The nosurgery group had significantly worse overall survival (OS) than the surgery group (hazardratio=3.34; 95% confidence interval=1.66–6.72; p<0.001), after adjustment for age, CCI, anddose reductions. Conclusions: A significant proportion of women treated with NACT do not undergo IDS, andthese women are older, frailer, and have worse OS. More studies are needed to find optimaltherapies to maximize outcomes in this high-risk, elderly population.
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