4.4 Article

Patterns of diaphragm involvement in stage 3B/3C ovarian-tubal-peritoneal epithelial cancer patients and survival outcomes

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ARCHIVES OF GYNECOLOGY AND OBSTETRICS
卷 303, 期 1, 页码 241-248

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SPRINGER HEIDELBERG
DOI: 10.1007/s00404-020-05802-0

关键词

Diaphragm; Ovarian cancer; Survival; Thoracotomy; Cytoreduction; Surgery

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The study demonstrates that involvement of diaphragm muscle is associated with higher risk of thorax recurrences and worse survival outcomes in patients with stage 3B and 3C ovarian-tubal-peritoneal epithelial cancers, suggesting the need for careful consideration when selecting adjuvant treatments.
Purpose Demonstrate survival outcomes of stage 3B/3C ovarian-tubal-peritoneal epithelial cancer patients who had metastases on diaphragm. Methods 141 patients who had undergone diaphragm surgery as a part of primary cytoreductive surgery procedures performed for stage 3B and 3C ovarian-tubal-peritoneal epithelial cancers were reviewed retrospectively. Patients who were administered neoadjuvant chemotherapy and patients who were suboptimally cytoreduced were not included to the study. Results Median follow-up time was 42 months. Median overall survival of the patients who underwent diaphragm full-thickness resection (n = 18) because of tumors infiltrating diaphragm muscle was 40 months. Median overall survival of the patients who did not have a transdiaphragmatic thoracotomy (n = 113) was 77 months. Patients who underwent a willful full-thickness diaphragm resection because of tumors invading diaphragm muscle had significantly shorter survival compared with patients who did not have a transdiaphragmatic thoracotomy (p = 0.033). Seven (38.9%) of the 18 patients who underwent diaphragm full-thickness resection developed a recurrence in thorax. Twelve (9.8%) of the remaining 123 patients developed a recurrence in thorax. Patients who underwent full-thickness diaphragm resection because of tumors infiltrating diaphragm muscle developed recurrence in the thorax more frequently (p = 0.001). Conclusions Diaphragm muscle involvement is a predictor of thorax recurrences and worse survival outcomes in stage 3B and 3C ovarian-tubal-peritoneal epithelial cancers. Thus, this should be considered when selecting appropriate adjuvant treatment and route of administration (intravenous/intraperitoneal) in patients who had diaphragm implants infiltrating diaphragm muscle.

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