Survival Rate Analysis Of Patients With Advanced Ovarian Cancer Treated According To Different Protocols

摘要

PURPOSE: Certain indications point out that application of systemic chemotherapy prior to radical surgery can influence the length of remission period as well as overall survival. Aim of this paper is to analyse progression-free survival and overall survival rates of patients with advanced ovarian carcinoma primary treated according to different therapeutical procedures: by systemic chemotherapy after which underwent citoreductive surgery and those treated by radical surgery and received chemotherapy and to compare survival data.PATIENTS AND METHODS: This study included 168 patients with advanced ovarian carcinoma. Patients were divided in four groups. First group of patients underwent systemic chemotherapy prior to radical surgery. Patients of second and third group first had radical surgery followed by chemotherapy; after chemotherapy, patients from the second group underwent citoreductive surgery. Patients from the fourth group were treated with systemic chemotherapy only. Progression-free survival and overall survival rate were calculated according to Kaplan-Mayer method. Log Rang test was used to compare survival rates.RESULTS: The longest progression-free survival (28 months) and overall survival rate (43 months) was recorded for patients subjected to radical surgery after systemic chemotherapy. Their survival was significantly better (p<0.01) than survival of patients who first underwent radical surgery after which chemotherapy was applied and especially better than survival of patients who were administered chemotherapy only (p<0.0001) since their survival data was the worst (6 months progression-free and 14 months overall).CONCLUSION: Application of systemic chemotherapy prior to radical surgery has been proven efficient in treatment and survival of patients with advanced ovarian carcinoma. INTRODUCTION Possible survival assessment of ovarian carcinoma patients is very complex and requires analysis of a great number of factors which can influence survival. The most important factors are disease stadium, age and residual tumour after laparotomy, histopathological type and clinical stage of the disease [1]. Each of these factors influence patient survival in a certain way, аnd their analysis is a complex issue which is still a very frequent focus of interest of scientists around the world. Surgical cytoreduction is the key factor influencing survival of patients with advanced ovarian carcinoma. Nevertheless, it is not always possible to perform surgical cytoreduction due to numerous possible complications [2, 3]. This is why in recent years various references often include discussions about when radical surgery should be applied аnd when systemic chemotherapy should be used, i.e. which is the optimal moment for radical surgical treatment of patients with advanced ovarian carcinoma [4]. The role of systemic chemotherapy prior to radical surgery becomes even more important when taken into account that it facilitates subsequent performance of optimal radical cytoreduction, which is still the key factor influencing the survival data, coupled with the possibility of intraoperative intraperitoneal application of chemotherapy drugs which, according to the most recent research, treatment doubles survival length [5, 6]. OBJECTIVE To analyse progression-free survival and the overall survival rates of patients with advanced ovarian carcinoma treated according to different protocols: by systemic chemotherapy before radical surgery, by radical surgery after which received chemotherapy and cytoreductive surgery and to compare survival data. PATIENTS AND METHODS This study included 168 patients with advanced ovarian carcinoma who were treated and subjected to surgery in University Clinic for Obstetrics and Gynaecology “Narodni Front” in Belgrade in the period 2007-2010. The research was organized as a prospective study. Patients were divided in four groups. First group of patients underwent systemic chemotherapy prior to radical surge