卵巢癌术后腹腔和静脉联合化疗的可行性  

Intraperitoneal chemotherapy combined with intravenous chemotherapy after operation in the ovarian epithelial cancer

作　　者：朱建龙[1] 冯令达[1] 翁雷[1] 邵敬於[1] 陆慧娟[1] 蔡树模[2] 

机构地区：[1]上海市第一妇婴保健院妇科,上海200040 [2]复旦大学附属肿瘤医院妇科

出　　处：《中国癌症杂志》2005年第6期561-565,共5页China Oncology

摘　　要：目的:探讨手术后用腹腔联合静脉化疗对卵巢癌治疗的可行性。方法:将卵巢上皮性癌88例分为两组:①联合化疗组:腹腔用药及静脉联合用药组,45例,Ⅰ/Ⅱ期21例(23.86%),Ⅲ/Ⅳ期24例(27.27%),在术中置入腹腔化疗管,术后每周1次腹腔化疗,用顺铂(DDP)与氟尿嘧啶(5-FU)为主加丝裂霉素C(MMC)或消瘤芥(AT-1258)的一种,共用3次。以后用静脉化疗,同静脉化疗组方案;②静脉化疗组(静脉用药组):43例,化疗方案为CAP,每3周一次,Ⅰ/Ⅱ期24例(27.27%),Ⅲ/Ⅳ期19例(21.59%)。结果:联合化疗组与静脉化疗组的患者在第3及6疗程结束后CA125下降程度Ⅰ/Ⅱ期与Ⅲ/Ⅳ期分别比较,差异有显著性(P值均<0.05)。第3疗程治疗后CA125>35u/ml的患者与CA125<35u/ml的患者3年生存率用Log Rank检验,差异有显著性(P<0.05)。联合化疗组与静脉化疗组的Ⅰ/Ⅱ期平均生存期分别为(35.05±0.54)、(32.38±1.19)个月,联合化疗组与静脉化疗组的Ⅲ/Ⅳ期平均生存期分别为(31.33±1.41)、(28.26±1.88)个月。联合化疗组与静脉化疗组Ⅰ/Ⅱ期3年生存率用Log Rank检验,两组差异无显著性(P值为0.156);联合化疗组与静脉化疗组Ⅲ/Ⅳ期3年生存率用LogRank检验,两组差异无显著性(P值为0.08)。有腹水70例的患者中联合化疗组3年生存率与静脉化疗组相比较,差异有显著性(P<0.05)。结论:术后用腹腔联合静脉化疗对卵巢癌治疗,可使血清CA125下降较明显,差异有显著性。3个疗程治疗后血清CA125<35u/ml与CA125>35u/ml的患者3年生存率差异有显著性。虽然术后联合化疗组与静脉化疗组相比较3年生存率差异无显著性,但是腹腔联合静脉化疗平均生存期较长。有腹水的患者经腹腔联合化疗3年生存率与单纯的静脉化疗相比较差异有显著性,故腹腔联合静脉化疗适用于有腹水及腹腔有转移灶的卵巢癌患者。Purpose： To study the intraperitonal chemotherapy combined with intravenous chemotherapy after surgery for the treatment of ovarian cancer. Methods： The 88 patients of ovarian cancer after cytoreductive surgery were divided into two groups A and B. A group（45 cases） received intraperitonal chemotherapy three times once a week with DDP and 5-FU plus either the MMC or AT-1258, then intravenous chemotherapy, stages Ⅰ/Ⅱ 21 cases（23.86% ）, stages Ⅲ/Ⅳ 24 cases （ 27.27% ）. B groups were given intravenous chemotherapy with CAP protocol once every three weeks, stage Ⅰ/Ⅱ 24 cases（27.27% ）, stages Ⅲ/Ⅳ 19 cases（21.59% ）. Results： After three or six courses of chemotherapy there was significant decrease in CA125 both Ⅰ/Ⅱand Ⅲ/Ⅳ in A and B groups . After three courses of chemotherapy there were 34 cases （ 38.64% ） of A groups and 19 cases（ 21.59% ） of the B groups with CA125 〈 35 u/ml. Three-year survival rate was significantly different between CA125 〈35 u/ml（53 cases） and CA125 〉 35 u/ml（35 cases） who were given three courses of chemotherapy after entire treatment. A and B groups in the Ⅰ/Ⅱ stages showed average survival time （35.05 ± 0.54）, （32.38 ± 1.19） lnonths, and in the Ⅲ/Ⅳ stages showed average survival time （31.33 ± 1.41）, （28.26 ± 1.88） months. There was no significance （P=0. 156） with three year survival rate between A and B groups in the Ⅰ/Ⅱ stages with Log Rank test. There was no significance （P =0.08） in three-year survival rate between A and B groups in the Ⅲ/Ⅳ stages with Log Rank test. There was significance in three-year survival rate between A and B with intraperitonal fluid. Conclusions： The intraperitonal chemotherapy combined with intravenous chemotherapy after surgery for the treatment of ovarian cancer could marketly decrease CA125 than intravenous chemotherapy after three or six courses. Three-year survival rate was significantly different between CA125〈35u/ml（53cases）and CA

关 键 词：卵巢癌 腹腔化疗 静脉化疗 CA125 

分 类 号：R737.3[医药卫生—肿瘤]