晚期卵巢癌腹腔洗涤细胞学在间隔减瘤手术中的预后分析

继新辅助化疗后的间隔减瘤手术（IDS）是晚期卵巢癌的治疗选择之一。最佳手术操作对于改善生存率至关重要；然而，虽然腹腔洗涤细胞学（PWC）已被确定为预后因素，但在IDS期间对其的全面评估仍未被探索。因此，我们旨在通过回顾2017年1月至2023年6月期间接受新辅助化疗和IDS的25例晚期卵巢癌患者的医疗记录，评估PWC在IDS中的有效性，以及其他因素如残余病变和模型癌抗原125（CA-125）ELIMination rate constant K（KELIM）。其中12例（48.0%）患者PWC为阳性，其余为阴性。PWC在IDS期间在剖腹探查时进行，之后有5例（41.7%）PWC阳性和4例（30.8%）PWC阴性患者接受了贝伐单抗（一种抗血管内皮生长因子单克隆抗体）作为维持治疗。4例（33.3%）PWC阳性和10例（76.9%）PWC阴性患者接受多腺苷二磷酸（ADP）-核糖聚合酶（PARP）抑制剂。在接受贝伐单抗和PARP抑制剂治疗的患者中，PWC阳性与阴性者的总生存期和无进展生存期无显著差异（p=0.27和0.20）。无进展生存期在CA-125 KELIM较佳与较差者之间存在显著差异（p=0.02）。多变量分析显示，最佳手术和有利的CA-125 KELIM与更好的无进展生存期相关（p<0.01和0.02），只有最佳手术与更好的总生存期相关（p=0.04）。在IDS时PWC阳性与晚期卵巢癌患者的生存无显著关联。我们的研究结果表明，尽管IDS时PWC状态应作为影响患者生存的因素之一，但近年来维持治疗的改善可能使CA-125 KELIM与PWC状态的结合成为选择治疗方案的更有用的预后指标。未来需要进一步研究以验证这些结果，强调维持治疗在IDS后的潜在重要性以及进一步验证阳性PWC临床意义的必要性。

Interval debulking surgery (IDS) following neoadjuvant chemotherapy is a treatment option for advanced ovarian cancer. Optimal surgery is required for better survival; however, while peritoneal washing cytology (PWC) has been identified as a prognostic factor, its comprehensive assessment during IDS remains unexplored. Therefore, we aimed to evaluate PWC efficacy during IDS, alongside other factors including residual disease and the modeled cancer antigen 125 (CA-125) ELIMination rate constant K (KELIM), by retrospectively reviewing the medical records of 25 patients with advanced ovarian cancer underwent neoadjuvant chemotherapy and IDS between January 2017 to June 2023.Twelve (48.0%) patients were PWC-positive, and the remainder were PWC-negative. PWC was performed at laparotomy during IDS, after which five (41.7%) PWC-positive and four (30.8%) PWC-negative patients received bevacizumab, an anti-vascular endothelial growth factor monoclonal antibody, for maintenance treatment. Four (33.3%) PWC-positive and 10 (76.9%) PWC-negative patients received poly adenosine diphosphate (ADP)-ribose polymerase inhibitors. In patients who received bevacizumab and poly ADP-ribose polymerase inhibitors, overall survival and progression-free survival did not significantly differ between those who were PWC-positive and PWC-negative (p = 0.27 and 0.20, respectively). Progression-free survival significantly differed between those with favorable and unfavorable CA-125 KELIM (p = 0.02). Multivariate analysis indicated that optimal surgery and favorable CA-125 KELIM were associated with better progression-free survival (p < 0.01 and 0.02, respectively), with only optimal surgery associated with better overall survival (p = 0.04).A positive PWC at IDS was not associated with survival in advanced ovarian cancer. Our findings indicate that although PWC status at IDS should be one of the factors determining survival in patients with advanced ovarian cancer, recent improvements in maintenance therapy may make the combination of CA-125 KELIM and PWC status a more useful prognostic factor in selecting treatment after IDS. Further studies are needed to validate these results, highlighting the potential importance of maintenance treatment after IDS and the need for further research to validate the clinical significance of a positive PWC.