晚期卵巢上皮癌耐药分析及复发后治疗  

Platinum-resistance in advanced epithelial ovarian carcinomas and treatment for different recurrent diseases

作　　者：梁旭东[1] 曾浩霞[2] 祝洪澜[1] 冯岩岩[1] 尹璐瑶[1] 崔恒[1] 魏丽惠[1] 

机构地区：[1]北京大学人民医院妇产科,北京100044 [2]首都医科大学朝阳医院妇产科

出　　处：《现代妇产科进展》2011年第11期841-845,共5页Progress in Obstetrics and Gynecology

基　　金：北京市自然科学基金(No:7082098)

摘　　要：目的:分析晚期卵巢上皮癌的耐药情况及复发后治疗,探讨化疗敏感性对预后的影响。方法:按初治后的无瘤间期(disease free interval,DFI)将176例患者分为R组(铂耐药,DFI<6个月)和S组(铂敏感,DFI>6个月)两组,S组再分为S1组(铂部分敏感,DFI为6～12个月)和S2组(铂敏感,DFI>12个月)两组,分析各组患者的临床特征、复发情况、复发后治疗及预后。结果:176例晚期卵巢上皮癌,平均发病年龄54.01±10.19(23～77)岁,69.3%为浆液性,71.6%为低分化,淋巴转移率42.8%,30.1%原发耐药,总5年生存率45.4%,中位OS为56个月,中位PFS为24个月。R组(铂耐药)和S2组(铂敏感)的中位OS和PFS有显著差异,S1组的中位OS及中位PFS分别为40和17个月,介于铂耐药、铂敏感之间。S1组的肿瘤、术前CA125、盆腔腹主动脉旁淋巴结转移率也介于铂耐药以及铂敏感患者之间,其初次手术达满意肿瘤减灭的比例为13.8%,显著低于铂敏感者(29.8%)(P=0.047)。铂部分敏感患者复发后,更换化疗方案者中位OS较继续使用TC/TP或CAP化疗者略长,但无统计学意义(P=0.081)。结论:将铂部分敏感患者单独分类有意义,此类患者复发后的治疗措施尚无定论,有待进一步研究。Objective：To analyze the status of platinum-resistance in advanced epithelial ovarian carcinomas and treatment for recurrent diseases.To investigate the effect of chemosensitivity on prognosis.Methods：According to the length of disease free interval,176 patients with advanced epithelial ovarian carcinoma were divided into two groups：group R（platinum-resistant,DFI6 months）and group S（platinum-sensitive,DFI6 months）.Group S was divided into two subgroups：group S1（partially sensitive,DFI 6-12months）and group S2（platinum-sensitive,DFI12 months）.The differences of clinical features,recurrence,relapse treatment and prognosis among the 3 groups were compared.Results：Among 176 patients with advanced epithelial ovarian carcinoma,the mean age was 54.01±10.19（23~77）years old,69.3% were serous adenocarcinoma,71.6% were poorly differentiated,rate of lymph node metastasis was 42.8%,the primary resistant rate to platinum-based chemotherapy was 30.1%,the five-year survival rate was 45.4%,median OS was 56 months,median PFS was 24 months.There was statistically significanct difference of the median OS and PFS between group R and group S2.The median OS and PFS of partially sensitive group were 40 and 17 months,which was between sensitive and resistant group.CA125 level and lymph node metastasis rate of partially sensitive group fall in between sensitive and resistant group.The rate of optimal cytoreductive surgery in partially sensitive group was 13.8%,significantly lower than that in platinum-sensitive group（P=0.047）.Partially sensitive patients with other chemotherapy regimen in recurrent diseases had longer OS than that in patients with platinum-based combination chemotherapy,but there had no significant different（P=0.081）.Conclusion：It is necessary to divide partially-sensitive patients from platinum-sensitive group.What chemotherapy regimen should be used for recurrent disease of partially-sensitive patients needs further study.

关 键 词：晚期卵巢癌 化疗 部分敏感 预后 

分 类 号：R737.33[医药卫生—肿瘤]