Abstract

Background

The recent improvements in anti-cancer therapy following first-line treatment can potentially impact post-progression survival. We evaluated the factors that influence post-progression survival in advanced recurrent ovarian cancer.

Methods

Eighty-nine patients who underwent first-line treatment between June 2005 and December 2017 were included. The post-progression survival was defined as the difference between overall survival and initial progression-free survival. The effects of age, histology, stage, optimal surgery, secondary debulking surgery, bevacizumab administration, platinum sensitivity, and olaparib maintenance in recurrence were compared and independent risk factors were determined.

Results

The median follow-up duration was 60.0 months (range: 2–181). Platinum-sensitive recurrence had longer post-progression survival than platinum-resistant (P < 0.001). Inclusion of bevacizumab in first-line treatment did not produce a significant difference in post-progression survival (P = 0.462). Secondary debulking surgery (P = 0.013), bevacizumab administration (P < 0.001), and olaparib maintenance (P = 0.001) during recurrence increased post-progression survival. In multivariate analysis, histologies other than serous or endometrioid (hazard ratio = 2.389; 95% confidence interval = 1.200–4.754; P = 0.013) and non-bevacizumab usage in recurrence (hazard ratio = 4.484; 95% confidence interval = 1.939–10.370; P < 0.001) were independently correlated with poorer prognosis. Bevacizumab administration beyond progressive disease elicited improved post-progression survival (P < 0.001). In patients receiving bevacizumab in first-line treatment, exclusion of bevacizumab in the recurrent therapy (hazard ratio = 5.507; 95% confidence interval = 2.301–12.124; P < 0.001) was independently correlated with poorer prognosis.

Conclusions

The continuous use of bevacizumab beyond progressive disease improves post-progression survival suggesting its important role in first-line and recurrence treatment for ovarian cancer.

中文翻译：

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贝伐单抗的使用与晚期复发性卵巢癌进展后生存期的改善相关

摘要

背景

一线治疗后抗癌治疗的最新进展可能会影响进展后的生存。我们评估了影响晚期复发性卵巢癌进展后生存的因素。

方法

纳入了 2005 年 6 月至 2017 年 12 月期间接受一线治疗的 89 名患者。进展后生存期定义为总生存期与初始无进展生存期之间的差异。比较了年龄、组织学、分期、最佳手术、二次减瘤手术、贝伐单抗给药、铂敏感性和奥拉帕尼维持治疗对复发的影响，并确定了独立危险因素。

结果

中位随访时间为 60.0 个月（范围：2-181）。铂类敏感复发的进展后生存期比铂类耐药（P  < 0.001）长。将贝伐单抗纳入一线治疗并未对进展后生存产生显着差异（P  = 0.462）。 复发期间二次减瘤手术 ( P  = 0.013)、贝伐珠单抗给药 ( P  < 0.001) 和奥拉帕尼维持治疗 ( P = 0.001) 增加了进展后生存率。在多变量分析中，浆液性或子宫内膜样以外的组织学（风险比 = 2.389；95% 置信区间 = 1.200–4.754；P = 0.013) 和非贝伐单抗使用复发（风险比 = 4.484；95% 置信区间 = 1.939–10.370；P  < 0.001）与较差的预后独立相关。疾病进展后贝伐珠单抗的给药引起了进展后生存期的改善（P  < 0.001）。在一线治疗中接受贝伐单抗的患者中，在复发性治疗中排除贝伐单抗（风险比 = 5.507；95% 置信区间 = 2.301–12.124；P  < 0.001）与较差的预后独立相关。

结论

贝伐单抗在疾病进展后的持续使用可提高进展后的生存率，表明其在卵巢癌的一线和复发治疗中具有重要作用。