首次肿瘤细胞减灭术与新辅助化疗后间隔性肿瘤细胞减灭术治疗Ⅲ和Ⅳ期卵巢癌患者后其对铂类药物耐药性及生存期的影响  

Influence of Primary Debulking Surgery and Neoadjuvant Chemotherapy Interval Debulking Surgery on Plantinum Drug Resistance and Survival Time in the Treatment of Patients with Stage Ⅲ and Ⅳ Ovarian Cancer

作　　者：成莉[1] 李琳[1] 邢辉[1] 

机构地区：[1]湖北文理学院附属医院襄阳市中心医院妇产科,湖北省襄阳市441021

出　　处：《中国全科医学》2014年第9期1021-1025,共5页Chinese General Practice

基　　金：湖北省自然科学基金项目(2012FFB01904)

摘　　要：目的探讨首次肿瘤细胞减灭术(PDS)与新辅助化疗后间隔性肿瘤细胞减灭术(NACT-IDS)治疗Ⅲ和Ⅳ期卵巢癌患者后其对铂类药物耐药性及生存期的影响。方法选择我院2006年1月—2008年2月收治的晚期(Ⅲ和Ⅳ期)卵巢癌患者116例,根据治疗方法分为PDS组及NACT-IDS组,比较两组患者糖类蛋白125(CA125)水平及治疗情况,治疗后对铂类药物的敏感性,中位无病生存期及中位总生存期。多因素非条件Logistic回归分析各项基线资料、病理特征与铂类药物耐药性的关系。结果 PDS组与NACT-IDS组CA125水平〔(1 568±436)U/ml与(1 664±325)U/ml〕比较,差异无统计学意义(t=1.362,P>0.05);PDS组患者化疗周期>6的患者较NACT-IDS组减少,腹腔化疗的患者较NACT-IDS组增多(P<0.05)。停止化疗6个月后,NACT-IDS组耐药26例(44.8%),多于PDS组的17例(29.3%)(χ2=6.421,P<0.05)。多因素非条件Logistic回归分析结果显示,治疗方法、年龄、化疗周期、腹腔化疗、铂类联合紫杉醇与第一个周期对化疗有反应的患者铂类药物耐药有回归关系(P<0.05);治疗方法、国际妇产科联盟(FIGO)分期、年龄、铂类联合紫杉醇与经过≥4周期化疗的患者铂类药物耐药有回归关系(P<0.05)。NACT-IDS组和PDS组中位无病生存期均为16个月,差异无统计学意义(χ2=1.243,P=0.541),而中位总生存期则NACT-IDS组显著低于PDS组(33个月与45个月,χ2=6.153,P=0.013)。多因素Cox回归分析结果显示,治疗方法、FIGO分期、年龄、化疗周期、腹腔化疗、铂类联合紫杉醇与患者生存期有回归关系(P<0.05)。结论 NACT-IDS方案在FIGOⅢ和Ⅳ期卵巢癌的治疗中较PDS方案可增加肿瘤对铂类的耐药性,并且减少患者中位总生存期。Objective To explore influence of primary debulking surgery（PDS） and neoadjuvant chemotherapy interval debulking surgery（NACT-IDS） on plantinum drug resistance and survival time in the treatment of patients with stage Ⅲ and Ⅳ ovarian cancer.Methods 116 patients with stage Ⅲ and Ⅳ ovarian cancer admitted to our hospital from January 2006 to February 2008 were divided into PDS group and NACT-IDS group.The CA125 level,sensitivity to platinum drugs,median disease-free survival and median overall survival were compared between the two groups.Multivariate Logistic regression analysis was performed for the baseline data,pathological features and resistance of platinum dugs.Results The CA125 levels between the PDS group and NACT-IDS group [（1 568±436） U/ml vs.（1 664±325） U/ml] showed no statistically significant difference（t=1.362,P〉0.05）.Patients with chemotherapy circle〉6 in PDS group were decreased compared with the NACT-IDS group,while patients with celiac chemotherapy were increased in PDS group（P〈0.05）.6 months after chemotherapy,26 cases（44.8%） in NACT-IDS group had drug resistance,more than the 17 cases（29.3%） in the PDS group（χ2=6.421,P〈0.05）.Multivariate Logistic regression analysis showed that treatment method,age,chemotherapy circle,celiac chemotherapy and the combination of platinum drugs and taxol were correlated with the platinum drug resistance among the patients responsive to the first circle chemotherapy（P〈0.05）.The treatment method,FIGO staging,age and the combination of platinum drugs and taxol were correlated with patients with over 4 circles of chemotherapy（P〈0.05）.The median disease-free survivals of the two groups were both 16 months,showing no statistically significant difference（χ2=1.243,P=0.541）.The median overall survival of the NACT-IDS group was significantly lower than the PDS group（33 months vs.45 months,χ2=6.153,P=0.013）.Multivariate Cox regression analysis showed that treatment method,FIGO staging,age,chemothera

关 键 词：卵巢肿瘤 肿瘤细胞减灭术 抗肿瘤联合化疗方案 抗药性 肿瘤 

分 类 号：R737.31[医药卫生—肿瘤]