老年晚期卵巢癌患者不同手术方式的预后分析

摘要/Abstract

摘要：

目的探讨老年晚期卵巢癌患者不同手术方式的预后差异。方法基于监测、流行病学和最终结果（SEER）数据库构建2000至2020年老年晚期卵巢癌患者队列，并从两种手术方式患者中通过倾向评分匹配筛选出2 094例患者构成匹配队列（SEER数据库队列），其中接受肿瘤细胞减灭术1 039例，接受局部切除术1 055例。同时，筛选2012年1月至2024年1月于bobapp1中国有限公司第一附属医院就诊的148例老年晚期卵巢癌患者（医院队列），其中接受肿瘤细胞减灭术85例，接受局部切除术63例。分别评估两个队列及国际妇产科联盟（FIGO）分期分层接受肿瘤细胞减灭术和局部切除术患者的预后差异。分析老年晚期卵巢癌患者死亡原因与手术方式间的关系。结果SEER数据库队列接受肿瘤细胞减灭术和局部切除术患者中位总生存期（OS）分别为37、40个月，5年OS率分别为31.47%、33.74%，差异无统计学意义（χ²=0.78，P=0.378）。按FIGO分期分层后，ⅢB~ⅢC期接受肿瘤细胞减灭术（n=998）和局部切除术（n=962）患者中位OS分别为38、40个月，差异无统计学意义（χ²=0.20，P=0.659）；Ⅳ期接受肿瘤细胞减灭术（n=41）和局部切除术（n=93）患者的中位OS分别为17、36个月，差异有统计学意义（χ²=9.37，P=0.002）。2 094例老年晚期卵巢癌患者中死因明确的患者共有1 581例。肿瘤细胞减灭术患者因卵巢癌死亡和非卵巢癌死亡的占比分别为94.52%（742/785）、5.48%（43/785），局部切除术患者因卵巢癌死亡和非卵巢癌死亡的占比分别为91.46%（728/796）、8.54%（68/796），两种手术方式在死亡原因分布上的差异有统计学意义（χ²=5.69，P=0.017）。医院队列接受肿瘤细胞减灭术和局部切除术患者中位OS分别为39、51个月，5年OS率分别为22.85%、23.81%，差异有统计学意义（χ²=6.71，P=0.010）。按FIGO分期分层后，ⅢB~ⅢC期接受肿瘤细胞减灭术（n=29）和局部切除术（n=26）患者中位OS分别为50、51个月，差异无统计学意义（χ²=0.15，P=0.699）；Ⅳ期接受肿瘤细胞减灭术（n=56）和局部切除术（n=37）患者中位OS分别为35、47个月，差异有统计学意义（χ²=6.55，P=0.011）。结论老年晚期卵巢癌患者实施局部切除术的生存结局不劣于肿瘤细胞减灭术。FIGO Ⅳ期患者局部切除术的生存期优于肿瘤细胞减灭术。

关键词:卵巢肿瘤,老年人,肿瘤细胞减灭术,预后,局部切除术

Abstract:

ObjectiveTo investigate the differences in prognosis between different surgical approaches in elderly patients with advanced ovarian cancer.MethodsBased on the Surveillance， Epidemiology and End Results （SEER） database， a cohort of elderly patients with advanced ovarian cancer from 2000 to 2020 was established. Through propensity score matching， 2 094 patients were selected from those who underwent two different surgical approaches to form a matched cohort （SEER database cohort）， including 1 039 patients who received cytoreductive surgery and 1 055 patients who underwent local resection. Meanwhile， 148 elderly patients with advanced ovarian cancer who were treated at the First Affiliated Hospital of Shandong First Medical University from January 2012 to January 2024 were selected （hospital cohort）， among whom 85 underwent cytoreductive surgery and 63 underwent local resection. The prognostic differences among patients who underwent cytoreductive surgery and local resection in two cohorts and stratified by the International Federation of Gynecology and Obstetrics （FIGO） staging were evaluated， respectively. The relationship between the causes of death and surgical approaches in elderly patients with advanced ovarian cancer was analyzed.ResultsIn the SEER database cohort， the median overall survival （OS） for patients who underwent cytoreductive surgery and local resection was 37 and 40 months， respectively， with 5-year OS rates of 31.47% and 33.74%， with no statistically significant difference （χ²=0.78，P=0.378）. After stratification by FIGO staging， the median OS for patients with stage ⅢB-ⅢC who underwent cytoreductive surgery （n=998） and local resection （n=962） was 38 and 40 months， respectively， with no statistically significant difference （χ²=0.20，P=0.659）. For patients with stage Ⅳ， the median OS for those who underwent cytoreductive surgery （n=41） and local resection （n=93） was 17 and 36 months， respectively， with a statistically significant difference （χ²=9.37，P=0.002）. Among 2 094 elderly patients with advanced ovarian cancer， 1 581 had clearly identified causes of death. In patients who underwent cytoreductive surgery， the proportions of deaths due to ovarian cancer and non-ovarian cancer were 94.52% （742/785） and 5.48% （43/785）， respectively. In patients who underwent local resection， the proportions of deaths due to ovarian cancer and non-ovarian cancer were 91.46% （728/796） and 8.54% （68/796）， respectively. There was a statistically significant difference in the distribution of causes of death between the two surgical approaches （χ²=5.69，P=0.017）. In the hospital cohort， the median OS for patients undergoing cytoreductive surgery and local resection was 39 and 51 months， respectively， with 5-year OS rates of 22.85% and 23.81%， with a statistically significant difference （χ²=6.71，P=0.010）. After stratification by FIGO staging， the median OS for patients with stage ⅢB-ⅢC undergoing cytoreductive surgery （n=29） and local resection （n=26） was 50 and 51 months， respectively， with no statistically significant difference （χ²=0.15，P=0.699）； for patients with stage Ⅳ undergoing cytoreductive surgery （n=56） and local resection （n=37）， the median OS was 35 and 47 months， respectively， with a statistically significant difference （χ²=6.55，P=0.011）.ConclusionsThe survival outcomes of local resection in elderly patients with advanced ovarian cancer are not inferior to those of cytoreductive surgery. For FIGO stage Ⅳ patients， the survival period following local resection is superior to that of cytoreductive surgery.

Key words:Ovarian neoplasms,Aged,Cytoreduction surgical procedures,Prognosis,Local resection

邱可欣, 李梦真, 国浩然, 凡梦思, 闫莉. 老年晚期卵巢癌患者不同手术方式的预后分析[J]. 国际肿瘤学杂志, 2025, 52(9): 576-582.

Qiu Kexin, Li Mengzhen, Guo Haoran, Fan Mengsi, Yan Li. Prognostic analysis of different surgical approaches in elderly patients with advanced ovarian cancer[J]. Journal of International Oncology, 2025, 52(9): 576-582.

图/表8

表1

SEER数据库总体队列及匹配队列老年晚期卵巢癌患者一般临床资料比较（$\bar{x} \pm s$/例）"

一般临床资料	总体队列				匹配队列
一般临床资料	局部切除术（n=1 071）	肿瘤细胞减灭术（n=2 728）	t/χ²值	P值	局部切除术（n=1 055）	肿瘤细胞减灭术（n=1 039）	t/χ²值	P值
年龄（岁）	69.73±7.09	69.59±6.85	0.30	0.763	69.77±7.09	70.01±6.90	1.02	0.308
肿瘤大小（mm）	84.58±8.38	83.51±7.38	0.94	0.347	84.54±8.39	82.21±5.91	1.30	0.193
种族
欧洲裔	936	2 371	0.17	0.918	923	924	1.44	0.487
非洲裔	59	154			58	46
亚洲裔	76	203			74	69
分化程度
Ⅲ	649	1 442	18.61	<0.001	644	601	2.22	0.136
Ⅳ	422	1 286	18.61	<0.001	411	438	2.22	0.136
偏侧性
右侧	273	567	18.63	<0.001	266	247	5.23	0.073
左侧	236	522			234	275
两侧	562	1 639			555	517
FIGO分期
ⅢB~ⅢC	976	2 491	0.03	0.858	962	998	20.72	<0.001
Ⅳ	95	237	0.03	0.858	93	41	20.72	<0.001
一般临床资料	总体队列				匹配队列
一般临床资料	局部切除术（n=1 071）	肿瘤细胞减灭术（n=2 728）	t/χ²值	P值	局部切除术（n=1 055）	肿瘤细胞减灭术（n=1 039）	t/χ²值	P值
化疗
否	188	308	26.58	<0.001	179	166	0.37	0.541
是	883	2 420	26.58	<0.001	876	873	0.37	0.541
放疗
否	1 052	2 701	3.95	0.047	1 036	1 031	4.37	0.058
是	19	27	3.95	0.047	19	8	4.37	0.058
婚姻状况
未婚	514	1 209	4.19	0.041	508	489	0.25	0.619
已婚	557	1 519	4.19	0.041	547	550	0.25	0.619

表1

图1

图2

图3

表2

医院队列老年晚期卵巢癌患者一般临床资料比较[M(Q1，Q3)/例]"

一般临床资料	肿瘤细胞减灭术（n=85）	局部切除术（n=63）	χ²/Z值	P值
年龄（岁）	65（61，72）	66（63，71）	-1.01	0.313
种族
欧洲裔	0	0		>0.999
非洲裔	0	0
亚洲裔	85	63
分化程度
Ⅲ	0	0		>0.999
Ⅳ	85	63		>0.999
FIGO分期
ⅢB~ⅢC	29	26	0.79	0.373
Ⅳ	56	37	0.79	0.373
并发症
是	9	4	0.81	0.368
否	76	59	0.81	0.368
化疗
是	84	63		>0.999
否	1	0		>0.999
放疗
是	2	1	<0.01	>0.999
否	83	62	<0.01	>0.999
免疫/靶向治疗
是	24	15	0.37	0.546
否	61	48	0.37	0.546
婚姻状况
未婚	0	0		>0.999
已婚	85	63		>0.999

表2

图4

图5

图6

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