卵巢透明细胞癌复发的时间与部位：JGOG/GCIG 3017-A3试验的分析
Investigating the timing and site of recurrence for ovarian clear cell carcinoma: Analysis of the JGOG/GCIG trial-JGOG 3017-A3
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影响因子:4.1
分区:医学2区 Top / 妇产科学1区 肿瘤学2区
发表日期:2024 Nov
作者:
M Yunokawa, N Kurihara, N Ishizuka, H Kanao, H Kajiyama, M Shimada, A Okamoto, D Aoki, T Sugiyama, T Enomoto
DOI:
10.1016/j.ygyno.2024.08.009
摘要
本研究旨在利用日本妇科肿瘤学组（JGOG）3017研究中入组患者的数据，确定卵巢透明细胞癌（OCCC）初次治疗后最佳监测方案。该研究评估了伊立替康与顺铂联合方案对比紫杉醇与卡铂方案在接受原发手术的OCCC患者中的疗效。共纳入619例患者，通过核平滑曲线估算事件发生的风险变化，分析无进展生存期（PFS）和总生存期（OS），以识别事件发生的高峰期。根据进展部位统计进展事件数，并考虑竞争风险，估算主要进展部位的累积发病比例。结果显示，进展或死亡的风险高峰出现在治疗后12个月，绝大多数事件在24个月内发生。死亡风险在18个月达到顶峰，大多数事件在48个月内出现。肺、肝及脾转移的风险在治疗后18个月保持稳定，随后呈下降趋势，绝大多数事件亦在18个月内发生。腹膜播散的风险在12个月内保持恒定，之后逐渐减少，大部分恶化发生在24个月内。骨盆复发的风险在6个月达到峰值，大多数恶化发生在24个月内。OCCC的进展事件发生高峰在12个月，且大多数在24个月内发生。建议在治疗后最初的24个月进行密切随访，之后减少访视，但应根据不同部位的进展速率差异，密切监测症状并进行检查。
Abstract
This study was conducted to determine the optimal monitoring after initial treatment of ovarian clear cell carcinoma (OCCC) using data from patients enrolled in the Japanese Gynecologic Oncology Group (JGOG) 3017 study. The JGOG study evaluated the efficacy of an irinotecan and cisplatin combination regimen compared with that of a paclitaxel and carboplatin regimen for OCCC patients who underwent primary surgery.Yielding 619 total patients in this study, to analyze progression-free and overall survival, the hazards over time were estimated using kernel smoothing curves to identify the peak of event occurrence. The number of progression events was summed by progression site, and the cumulative incidence proportion was estimated for the major progression sites, considering competing risks.The peak hazard for progression or death was observed at 12 months post-treatment, and most events were observed by 24 months. The hazard for death peaked at 18 months post-treatment, with most events being observed by 48 months. The hazard for lung, liver, and spleen metastases remained constant for 18 months post-treatment, with a decreasing trend thereafter; most events were observed by 18 months. The hazard for peritoneal dissemination was constant for 12 months, with a decreasing trend thereafter, with most exacerbations observed by 24 months. The risk of pelvic recurrence peaked at 6 months, with most exacerbations observed by 24 months.The incidence of progression events for OCCC peaked at 12 months and most progression events occurred within 24 months. Close follow-up for the initial 24 months post-treatment and fewer visits thereafter may be acceptable. However, closely monitoring symptoms and examining patients based on differences in progression rates at different sites may be important.