新辅助化疗对晚期卵巢癌治疗应用价值的评估及多因素分析  

Evaluate Value of Neoadjuvant Chemotherapy for Advanced Ovarian Cancer and Multivariate Analysis

作　　者：边策[1] 綦小蓉[1] 姚奎[1] 赵际童[1] 李黎[1] 赵霞[1] 

机构地区：[1]四川大学华西第二医院出生缺陷与相关妇儿疾病教育部重点实验室,四川成都610041

出　　处：《实用妇产科杂志》2016年第4期266-271,共6页Journal of Practical Obstetrics and Gynecology

基　　金：四川省医学科研青年创新课题(编号:Q14038)

摘　　要：目的:对晚期卵巢癌患者采用新辅助化疗的应用价值进行评估,及探讨新辅助化疗后间歇性肿瘤细胞减灭术满意缩瘤的标准。方法:回顾性研究2005年1月1日至2010年12月31日在四川大学华西第二医院住院治疗的晚期卵巢癌患者339例。比较225例接受初始肿瘤细胞减灭术及术后行辅助化疗(PDS组)和114例新辅助化疗联合间歇性肿瘤细胞减灭术(IDS组)患者的手术、围手术期并发症、无进展生存期(PFS)及总生存期(OS)。采用单因素和多因素分析晚期卵巢癌患者预后的独立因素,以及独立因素与晚期卵巢癌患者的临床及病理学特征与治疗方案选择间的关系。结果:1两组患者肿瘤细胞减灭术达到满意缩瘤的几率比较,差异无统计学意义(P>0.05)。但IDS组肿瘤细胞减灭术达到无肉眼残留病灶比例(39.47%)高于PDS组(27.56%)(P<0.05)。2IDS组术中出血量更少、输血比例更小、手术范围更小、手术时间更短、住院时间更短,差异有统计学意义(P<0.05)。3两组的PFS和OS比较差异无统计学意义(P>0.05)。多变量Cox回归分析结果患者肿瘤细胞减灭术后残留病灶大小(P<0.001)、FIGO分期(P<0.001)和年龄(P=0.003)是影响晚期卵巢癌患者OS的独立因素。4IDS组术后仅无肉眼残留病灶可提高患者的OS。FIGO分期与治疗方案选择间的关系有统计学意义(P=0.01),最大原发肿瘤直径与Ⅳ期卵巢癌患者治疗方案选择间的关系有统计学意义(P=0.07),通过STEPP分析,原发肿瘤直径的界值为8.6 cm。结论:新辅助化疗可以提高肿瘤细胞减灭术达到无肉眼残留的几率,缩小手术范围,减少围手术期并发症的发生,但不能提高患者的PFS和OS。新辅助化疗后间歇性肿瘤细胞减灭术中满意缩瘤的标准应为无肉眼残留病灶。患者的FIGO分期和最大原发肿瘤直径可能对晚期卵巢癌患者选择治疗方案提供帮助。Objective：To evaluate the value of neoadjuvant chemotherapy（NAC） for advanced ovarian canc- er,and to investigate standard of optimal cytoreduction for the patients operated interval debulking surgery after NAC. Methods：Patients（ n =339）with advanced ovarian cancer from January 2005 to December 2010 treated at West China Women＇s and Children＇s Hospital were retrospectively reviewed. The opportunity of optimal debulking surgery, surgery-related complications, progression-free survival （PFS） and overall survival （OS） were compared between primary debulking surgery（PDS） group（n =225） and NAC group（ n =114） followed by interval debulk- ing surgery（IDS）. Relationship between clinical or pathological characteristics and therapy alternative was ana- lyzed. Survival of patients with different residual tumor size after debulking surgery was compared. Results： ① There was no statistically significant difference on Optimal debulking rate between two groups（ P 〉 0. 05）. Howev-er,rate of complete debulking was significantly higher in NAC group （39.47%） compared to PDS group （27.56%） （P 〈0.05）.②Patients in NAC group suffered from less estimated blood loss, less transfusion, less aggressive surgical procedures, shorter duration of surgery and admission significantlythan in PDS group （ P 〈 0.05）. ③There was no difference in PFS or OS between two groups （ P 〉 0.05）. Postoperative residual tumor size（ P 〈 0. 001 ）, FIGO stage（ P 〈 0. 001 ）and age（ P = 0. 003） were independent prognostic factors in OS of pa- tients with advanced ovarian cancer with multivariate Cox regression analysis.④OS in NAC group was increased only in condition of no gross residual tumor. There was statistical significance between FIGO stage and therapy al- ternative（ P = 0.01 ）. The relationship between maximum diameter of primary tumor and therapy alternative a- mong epithelial ovarian cancer in 1V stage was statistical significance（ P = 0.07）, primary t

关 键 词：新辅助化疗 卵巢癌 肿瘤细胞减灭术 最大原发肿瘤直径 FIGO分期 

分 类 号：R737.31[医药卫生—肿瘤]