晚期卵巢癌患者的多模式预康复：PHOCUS随机试验
PHOCUS试验将103例接受新辅助化疗后行间歇性肿瘤减灭术的晚期卵巢癌患者随机分为多模式预康复组与标准护理组，72例完成术前评估纳入意向性分析。预康复组6分钟步行距离较基线显著增加（+36.0±11.8米，P=0.002），但组间差异未达统计学意义（P=0.236）；多个次要结局显示预康复组改善更显著。
要点
- 预康复组6分钟步行距离较基线显著增加36.0±11.8米，但组间差异无统计学意义。
- 预康复组在5次坐立试验、呼吸商和PONS评分上较标准护理组改善更显著。
- 手术结局、住院时间和术后并发症两组间无显著差异。
核心结论
- 新辅助化疗期间的多模式预康复可改善功能、营养和代谢参数，但主要终点组间差异未达统计学意义。
- 多个次要结局的一致获益支持将结构化预康复整合进晚期卵巢癌的ERAS路径。
研究设计与样本
- PHOCUS（NCT04789694）为前瞻性、多中心、随机试验，评估多模式预康复（身体活动/营养/心理辅导）。
- 纳入18-80岁接受新辅助化疗后行间歇性肿瘤减灭术的晚期卵巢癌患者，所有患者均按标准化ERAS方案治疗。
- 103例患者按1：1随机分为结构化多模式预康复组（B组）或标准护理组（A组），72例完成术前评估形成ITT人群。
- 主要终点为术前生理能力改善，以6分钟步行试验（6MWT）测量。
主要发现
- 从基线至术前，预康复组6MWT距离显著增加（平均+36.0±11.8米，P=0.002），标准护理组增加未达统计学意义（+22.6±9.2米，P=0.083）。
- 6MWT的组间差异未达统计学意义（P=0.236）。
- 预康复组在5次坐立试验、呼吸商和PONS评分上较标准护理组改善显著更优（均P<0.05）。
- 手术结局、住院时间或术后并发症方面未观察到显著差异。
临床怎么用
- 在新辅助化疗期间可考虑为晚期卵巢癌患者提供结构化多模式预康复，以改善功能、营养和代谢状态。
- 预康复应整合进ERAS路径，但需告知患者其主要终点组间差异未达统计学意义。
局限性
- 103例随机患者中仅72例完成术前评估形成ITT人群，脱落主要因疾病进展和撤回知情同意。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
INTRODUCTION: Prehabilitation is increasingly used to enhance fitness and postoperative outcomes in surgical oncology, yet supporting evidence in patients with advanced ovarian cancer remains limited. METHODS: PHOCUS (Prehabilitation in gynaecological Cancer patients; NCT04789694) was a prospective, multicentre, randomised trial evaluating multimodal prehabilitation-including physical-activity/nutritional/psychological counselling. Advanced ovarian cancer patients (18-80 years) undergoing neoadjuvant-chemotherapy (NACT) followed by interval debulking surgery, all treated under a standardised enhanced-recovery-after-surgery (ERAS) protocol, were randomised 1:1 to structured multimodal prehabilitation (Arm B) or standard care (Arm A). The primary endpoint was improvement in preoperative physiological capacity, measured by 6-Minute-Walk-Test (6MWT). RESULTS: Of the 103 patients randomised to Arms A and B, 72 completed presurgical assessments and formed ITT population, with attrition mainly due to disease progression and withdrawal of consent. From baseline to presurgery, 6MWT distance increased significantly in the prehabilitation arm (mean + 36.0 ± 11.8 m, P = 0.002), whereas the increase in the standard-care arm was not statistically significant (+22.6 ± 9.2 m, P = 0.083). The between-group difference did not reach statistical significance (P = 0.236). For secondary outcomes, prehabilitation arm demonstrated significantly greater improvements in the 5-times sit-to-stand test, respiratory quotient, and PONS score compared to standard care (all P < 0.05). No significant differences were observed in surgical outcomes, length of hospital stay, or postoperative complications. CONCLUSION: Multimodal prehabilitation during NACT was associated with improvements in functional, nutritional, and metabolic parameters. Although we did not find significant between-group difference of the primary endpoint, consistent benefits across selected secondary outcomes support the integration of structured prehabilitation into ERAS pathways for advanced ovarian cancer.
引用
- Borčinová M, Kníže M, Brtnický T, et al. Multimodal prehabilitation in patients with advanced ovarian cancer. Gynecol Oncol. 2026. PMID: 42155563. doi:10.1016/j.ygyno.2026.05.016
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。