探讨采取新辅助化疗(NACT)联合中间性肿瘤细胞减灭术(IDS)治疗晚期上皮性卵巢癌(EOC)患者的手术复杂性评分(SCS)、病变评分(DS)和术后残留病变(RD)的相关性。

选取2013年9月至2018年6月在四川大学华西第二医院接受NACT联合IDS治疗的160例晚期EOC患者为研究对象。采用回顾性分析方法，根据NACT联合IDS后是否达到肉眼无残留病灶(R0)，将其分别纳入R0组(n＝86)和RD组(n＝74)。收集2组患者的一般临床资料、实验室检查结果、术中切除组织病理学结果、术后并发症发生率及预后结果等。采用Mann-Whitney U检验、Pearson χ²检验或Fisher精确概率法等对2组患者临床病例资料进行统计学分析。采用多因素非条件logistic回归分析，对晚期EOC患者IDS达R0的影响因素进行分析。采用Mantel-Haenszel χ²检验对晚期EOC患者SCS与DS进行相关性分析。采用Log-rank法对R0组与RD组患者的总体生存(OS)率进行比较。本研究经四川大学华西第二医院医学伦理委员会批准，并遵循其伦理要求(审批文号：2022伦审批第167号)。

①RD组患者术前糖类抗原(CA)125水平高于R0组，并且差异有统计学意义(Z＝－2.52，P＝0.012)。②2组患者不同程度的DS构成比比较，差异有统计学意义(χ²＝10.92，P＝0.004)，不同程度SCS的构成比比较，差异有统计学意义(χ²＝15.41，P＝0.001)。多因素非条件logistic回归分析结果显示，DS为接受IDS后达R0的独立危险因素，中DS患者接受IDS较低DS患者更难达到R0(OR＝0.094, 95%CI：0.021~0.431，P＝0.002)，SCS为接受IDS后达R0的独立保护因素，中SCS患者接受IDS较低SCS患者更易达到R0(OR＝13.660, 95%CI：2.150~86.803，P＝0.006)。③Mantel-Haenszel χ²检验结果显示，晚期EOC患者的DS与SCS无趋势相关性(χ²＝0.01，P＝0.906)。④Log-rank检验提示2组患者生存曲线比较，差异有统计学意义(χ²＝9.46，P＝0.002)。⑤在术后有无并发症2组中，年龄、美国麻醉医师协会(ASA)分级、DS和SCS构成比比较，差异均无统计学意义(P>0.05)。

对接受NACT联合IDS治疗的晚期EOC患者，提高手术复杂度有助于实现R0并改善患者预后，但需权衡肿瘤负荷及术后并发症风险。建议术前综合评估及进行个体化决策。

To investigate the correlation between surgical complexity score (SCS), disease score (DS), and residual disease (RD) in patients with advanced epithelial ovarian cancer (EOC) undergoing interval debulking surgery (IDS), with the aim of informing individualized surgical decision-making.

A total of 160 patients with advanced EOC who underwent neoadjuvant chemotherapy (NACT) followed by IDS at West China Second University Hospital, Sichuan University, between September 2013 and June 2018 were retrospectively analyzed. According to whether complete cytoreduction (R0) was achieved, patients were categorized into the R0 group (n=86) and the RD group (n=74). Clinical data, including baseline characteristics, histopathological findings, laboratory results, postoperative complications, and prognosis, were collected for both groups. Statistical analyses were performed using the Mann-Whitney U test, Pearson′s chi-square test, or Fisher′s exact test, as appropriate, to compare clinical variables between the two groups. Multivariate unconditional logistic regression analysis was conducted to identify independent factors associated with achieving R0 resection in advanced EOC patients. The Mantel-Haenszel chi-square test was used to evaluate the correlation between SCS and DS. Kaplan-Meier survival analysis with the Log-rank test was employed to compare overall survival (OS) between the R0 and RD groups. This study was approved by the Ethics Committee of West China Second University Hospital, Sichuan University, and conducted in accordance with its ethical requirements (Approval No. 2022-167).

① The preoperative carbohydrate antigen 125 (CA125) level in the RD group was significantly higher than that in the R0 group (Z=-2.52, P=0.012). ② The distribution of DS grades between the two groups differed significantly was (χ²=10.92, P=0.004), the distribution of SCS between the two groups also differed significantly (χ²=15.41, P=0.001). DS was an independent risk factor for reaching R0 after receiving IDS, while SCS was an independent protective factor. Multivariate unconditional logistic regression analysis indicated that patients with moderate DS had a significantly lower likelihood of achieving R0 resection compared with those with low DS (OR=0.094, 95%CI: 0.021-0.431, P=0.002), whereas patients with moderate SCS were more likely to achieve R0 compared with those with low SCS (OR=13.660, 95%CI: 2.150-86.803, P=0.006). ③ Mantel-Haenszel χ² test revealed no significant trend correlation between DS and SCS in patients with advanced EOC (χ²=0.01, P=0.906). ④ The Log-rank test demonstrated that the survival curves of the two groups differed significantly (χ²=9.46, P=0.002). ⑤ Comparisons of age, American Society of Anesthesiologists (ASA) classification, DS grade, and SCS grade between patients with and without postoperative complications showed no significant differences (all P>0.05).

For patients with advanced EOC treated with NACT followed by IDS, increasing surgical complexity may facilitate the achievement of R0 resection and improve prognosis. However, such an approach requires careful consideration of tumor burden and the risk of postoperative complications. Preoperative comprehensive evaluation and individualized decision-making are therefore recommended.