在BRCA突变的晚期卵巢/腹膜/输卵管癌中,间隔与初级细胞还原手术的比较
Peter G Rose1, Sujata Patil2, Meng Yao2
1Cleveland Clinic Foundation, Obstetrics and Gynecology Institute, Cleveland, OH, USA.
概括
主要的细胞削减手术改善了总体存活率,并确定了BRCA突变卵巢癌患者的长期无病幸存者. 这种方法显示,无论第一线聚 (ADP-ribose) 聚合酶抑制剂的维护,都会产生好处.
科学领域:
- 妇科瘤学 妇科瘤学
- 手术瘤学手术瘤学
- 医学遗传学 医学遗传学
背景情况:
- 表皮卵巢/腹膜/输卵管癌 (EOC) 的分期影响治疗决策.
- 在EOC中,BRCA突变 (BRCAm) 影响治疗反应.
- 将新辅助化学疗法与间歇细胞还原手术 (ICR) 与初级细胞还原手术 (PCS) 进行比较对于优化结果至关重要.
研究的目的:
- 评估新辅助化疗和间隔细胞减小手术与初级细胞减小手术和辅助化疗对BRCA突变 (BRCAm) 和BRCA野生型 (BRCAwt) EOC.的生存结果的影响.
- 为了比较这些治疗策略之间的无进展生存率 (PFS),总生存率 (OS) 和长期无疾病生存率 (DFS).
主要方法:
- 从1991年到2021年,对具有BRCA生殖系/体质突变 (BRCAm) 和BRCA野生型 (BRCAwt) 的EOC患者进行了回顾性审查.
- 与接受ICR的新辅助化疗和接受PCS辅助化疗的患者之间的结局的比较.
- 分析包括国际妇科和产科联合会 (FIGO) 2013年的分期和手术复杂性的评估.
主要成果:
- 与PCS相比,在接受ICR的BRCAm患者中观察到明显减少的手术时间和手术复杂性.
- 与接受ICR的BRCAwt患者相比,接受ICR的BRCAm患者的手术复杂性降低了.
- 在PCS和ICR之间没有观察到PFS的显著差异,但在PCS组中没有接受多 (ADP-ribose) 聚合酶抑制剂 (PARPi) 的PCS组中观察到PFS的改善.
结论:
- 初级细胞还原性手术 (PCS) 对EOC患者的整体存活率 (OS) 显著改善,无论第一线PARPi维护情况如何.
- 长期没有疾病的幸存者 (>10年) 仅在PCS队列中被确定.
- 对于精选的EOC患者来说,PCS可能是一个优越的外科第一方法,特别是那些患有BRCA突变的患者.
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