针对国际妇科和妇产科联盟IV阶段IV卵巢癌的原发性与间隔细胞减少手术的生存结果：基于全国人群的目标试验仿真

原发性细胞减少手术与间隔细胞减少手术对国际妇科和妇产科联盟IV卵巢癌结果的影响仍然不确定，并且可能会因阶段和外肠外转移的位置而变化。 Emulating target trials through causal assessment, combined with propensity score adjustment, has become a leading method for evaluating interventions using observational data.This study aimed to assess the effect of primary vs interval cytoreductive surgery on progression-free and overall survival in patients with International Federation of Gynecology and Obstetrics stage IV ovarian cancer using target trial emulation.Using the comprehensive French national health insurance database, we emulated a target trial探索初级与间隔细胞减少手术对IV期卵巢癌预后的因果影响（卵巢癌的手术4：SOFI-4）。具有逆概率加权的克隆方法用于调整信息的审查和平衡两组之间的基线特征。根据阶段和外膜外转移位置进行亚组分析。这项研究包括在健康状况良好的75岁以下的患者中，他们在2014年1月1日至2022年12月31日之间被诊断出患有IV期卵巢癌。主要和次要结果分别为5年的无进展生存期和7年的整体生存期和7年的整体生存期。患有IVB期卵巢癌。对1182例患者（42.6％）进行了初次的细胞支出手术，而间隔细胞核手术进行了1590例患者（57.4％）。初级细胞减少手术的中值无进展生存期为19.7个月（四分位间范围为19.3-20.1），而不是15.7个月（四分位数范围为15.7-16.1），而间隔间隔手术的患者则为15.7个月（15.7-16.1）。与55.6个月相比，原发性细胞还原性手术的总生存期为63.1个月（四分位间范围为61.7-65.4），用于间隔细胞托管手术。我们研究的结果表明，原发性细胞减少手术与5年无进展生存期（95％置信区间，3.8-6.2）增加5.0个月有关，7年总生存期（95％的置信区间，1.9-6.2）增加了3.9个月。在国际妇科和妇产科联合会IVA和IVB亚组中都观察到了原发性超过间隔细胞减少手术的这些生存益处。初级细胞减少手术显示出无进展的生存率改善，并且在胸膜，超肾上腺超肌或腹外淋巴结转移的患者中，这项研究主张对诸如IV期OVARIANS癌症的超度细胞手术的原发性手术效果的益处，该研究的益处均具有间隔性手术的益处。腹外淋巴结不应自动排除合适患者的原发性细胞减少手术考虑。

The effect of primary cytoreductive surgery vs interval cytoreductive surgery on International Federation of Gynecology and Obstetrics stage IV ovarian cancer outcomes remains uncertain and may vary depending on the stage and the location of extraperitoneal metastasis. Emulating target trials through causal assessment, combined with propensity score adjustment, has become a leading method for evaluating interventions using observational data.This study aimed to assess the effect of primary vs interval cytoreductive surgery on progression-free and overall survival in patients with International Federation of Gynecology and Obstetrics stage IV ovarian cancer using target trial emulation.Using the comprehensive French national health insurance database, we emulated a target trial to explore the causal impacts of primary vs interval cytoreductive surgery on stage IV ovarian cancer prognosis (Surgery for Ovarian cancer FIGO 4: SOFI-4). The clone method with inverse probability of censoring weighting was used to adjust for informative censoring and to balance baseline characteristics between the groups. Subgroup analyses were conducted based on the stages and extraperitoneal metastasis locations. The study included patients younger than 75 years of age, in good health condition, who were diagnosed with stage IV ovarian cancer between January 1, 2014, and December 31, 2022. The primary and secondary outcomes were respectively 5-year progression-free survival and 7-year overall survival.Among the 2772 patients included in the study, 948 (34.2%) were classified as having stage IVA ovarian cancer and 1824 (65.8%) were classified as having stage IVB ovarian cancer at inclusion. Primary cytoreductive surgery was performed for 1182 patients (42.6%), whereas interval cytoreductive surgery was conducted for 1590 patients (57.4%). The median progression-free survival for primary cytoreductive surgery was 19.7 months (interquartile range, 19.3-20.1) as opposed to 15.7 months (interquartile range, 15.7-16.1) for those who underwent interval cytoreductive surgery. The median overall survival was 63.1 months (interquartile range, 61.7-65.4) for primary cytoreductive surgery in comparison with 55.6 months (interquartile range, 53.8-56.3) for interval cytoreductive surgery. The findings of our study indicate that primary cytoreductive surgery is associated with a 5.0-month increase in the 5-year progression-free survival (95% confidence interval, 3.8-6.2) and a 3.9-month increase in 7-year overall survival (95% confidence interval, 1.9-6.2). These survival benefits of primary over interval cytoreductive surgery were observed in both the International Federation of Gynecology and Obstetrics stage IVA and IVB subgroups. Primary cytoreductive surgery demonstrated improved progression-free survival and overall survival in patients with pleural, supradiaphragmatic, or extra-abdominal lymph node metastasis.This study advocates for the benefits of primary cytoreductive surgery over interval cytoreductive surgery for patients with stage IV ovarian cancer and suggests that extraperitoneal metastases like supradiaphragmatic or extra-abdominal lymph nodes should not automatically preclude primary cytoreductive surgery consideration in suitable patients.