复发性卵巢上皮癌二次细胞减灭术的临床意义  

Clinical significance of secondary cy toreductive surgery for recurrent advanced ovarian cancer

作　　者：臧荣余[1] 张志毅[1] 蔡树模[1] 

机构地区：[1]复旦大学附属肿瘤医院,上海200032

出　　处：《中华肿瘤杂志》2002年第2期194-196,共3页Chinese Journal of Oncology

摘　　要：目的　探讨复发性卵巢上皮癌二次细胞减灭术 (SCR)的作用及其影响因素。方法6 0例晚期卵巢上皮癌因肿瘤复发行SCR治疗。采用Cox逐步回归分析预后的影响因素 ;采用Logistic回归分析影响SCR的危险因素。结果　SCR术后残癌≤ 1cm组与 >1cm组的中位生存期分别为 19个月和 8个月 ,差异有显著性 (P =0 .0 0 0 0 )。缓解期 >12个月与≤ 12个月者 ,再手术后中位生存期分别为 12个月和 8个月 ,差异有显著性 (P =0 .0 2 2 4 )。肿瘤复发伴有腹水是预后的影响因素 ,同时也是影响SCR的主要危险因素。复发伴腹水者 ,SCR切净的可能减少了 2 0 .36倍。第 1次手术后残癌 >1cm是影响SCR的危险因素 (RR =5 .16 )。本组手术死亡率 1.7% ,术后并发症发生率 8.3%。结论　在有效二线化疗的配合下 ,SCR对首次行满意细胞减灭术、缓解期达 12个月以上。Objective To study the role of secondary cy toreductive sur gery (SCR) in patients with recurrent advanced epithelial ovarian cancer. Methods From Jan. 1986 to Dec. 1997, 60 women with recurrent advanced epithelial ovar ian cancer treated with SCR were retrospectively reviewed. Survival curves were computed using the Kaplan Meier method with differences in survival estimated by log ranK test. Independent prognostic factors were identified by C ox′s stepwise regression, and the affecting factors of SCR evaluated by Logisti c stepwise regression. Results Of the 60 patients, 23 (38.3%) were cy toreduced to small macroscopic residual (≤1cm) and 37 retained larger residual, with an estimated median survival of 19 months and 8 months respectively . Multivariate analy sis r evealed that residual disease ( P =0.004 1) after SCR, as well as refractory ascites ( P =0.019 1) and progression free interval ( P =0.011 6), were i ndependent factors of survival. Refractory ascites (relative risK =20.36, P =0 .007 2) and residual disease after primary surgery (relative risK=5.16, P = 0.009 6) were factors affecting SCR. Conclusion Secondary cy toreductive surgery is definitely effective in the treatment of rec urrent advanced epithelial o varian carcinoma, particularly in those who have received primary optimal cy tore duction with a progression free interval >12 months and without refractory asci tes. [

关 键 词：卵巢肿瘤 二次细胞减灭术 复发性卵巢上皮癌 治疗 临床意义 

分 类 号：R737.31[医药卫生—肿瘤]