244例卵巢上皮癌铂耐药情况及其对预后的影响  

Platinum-resistant in 244 epithelial ovarian carcinomas and the effect of chemosensitivity on prognosis

作　　者：曾浩霞[1] 梁旭东[1] 崔恒[1] 李艺[1] 祝洪澜[1] 

机构地区：[1]北京大学人民医院妇科肿瘤中心,北京100044

出　　处：《现代妇产科进展》2010年第6期401-405,共5页Progress in Obstetrics and Gynecology

基　　金：北京市自然科学基金资助(No:7082098)

摘　　要：目的:分析卵巢上皮癌对铂类为基础的联合一线化疗的耐药情况,探讨初治化疗敏感性对预后的影响。方法:按初治后无瘤间期(DFI)长短将患者分为铂耐药、铂部分敏感、铂敏感3组,比较各组患者的临床特征、复发治疗及预后情况。结果:244例患者的中位发病年龄52岁,晚期占72.1%,61.1%为浆液性,67.2%为低分化,淋巴转移率31.2%,原发耐药比率23.36%,总5年生存率54.7%,中位总生存时间(OS)为70个月,中位无疾病进展时间(PFS)为29个月。晚期、未达到满意肿瘤细胞减灭术的患者铂耐药几率增高(P<0.001,P<0.001)。铂耐药患者的CA125及淋巴转移率高于铂敏感组(P=0.03,P=0.003)。3组患者中任意两组的OS及PFS均有显著差异(P<0.001)。部分敏感患者复发后,更换化疗方案者中位OS较继续TC(TP)或CAP化疗者略长(P=0.196)。结论:中低分化的晚期患者,CA125超过1000U/ml,未达到满意肿瘤细胞减灭术,盆腔、腹主动脉旁淋巴结阳性,耐药或部分敏感的几率高,预后差。化疗敏感性不同的患者预后不同,复发后应选择不同的化疗方案。Objective：To investigate clinical features of epithelial ovarian carcinoma, response rate to platinum-based combination chemotherapy and the effects of chemosensitivity on prognosis. Method ：According to the length of disease free interval（DFI） ,244 patients were divided into 3 groups： platinum-resistant, partially sensitive, platinum-sensitive groups. The differences of clinical features, relapse treatment and prognosis were compared among the 3 groups. Results： In 244 patients with epithelial ovarian carcinoma, the median age was 52 years,72.1% was advanced stage,61. 1% was serous cancer,67.2% was poorly differentia- ted,rate of lymph node metastasis was 31.2%. The primary resistant rate to platinum-based chemotherapy was 23.36%. The five-year survival rate was 54.7% , median OS was 70 months, and the median PFS was 29 months. The platinum resistant percentage of patients with advanced stage and patients without optimal cytoreductive surgery was higher（P〈0. 001 ,P〈0. 001 ）. Platinum-resistant patients CA125 and lymph node metastasis rate were higher than those of platinum-sensitive patients （ P = 0.03, P = 0. 003 ）. There were significant differences among the 3 groups in overall survival（OS） and progression-free survival（P〈0. 001 ）. Partially sensitive pa- tients who were treated with other chemotherapy regimen after disease relapse had a little longer OS than patients with platinum-based combination chemotherapy（P=0. 196）. Conclusion：Advanced ovarian cancers with poor differentiation,lymph node metastasis, high CA125 level, andfailed to achieve optimal cytoreductive surgery are much more likely to resistant or partially sensitive to platinum. Patients with different response to platinum-based combination chemotherapy have different prognosis. Different treatment should be chosen for relapse.

关 键 词：卵巢肿瘤 化疗 耐药 预后 

分 类 号：R737.31[医药卫生—肿瘤]