晚期卵巢上皮性癌患者NACT+IDS治疗模式的预后获益及影响因素分析  

Analysis of factors related to the prognostic benefit of neoadjuvant chemotherapy followed by interval debulking surgery in patients with advanced ovarian cancer

作　　者：王登凤 张国楠 彭春蓉 石宇 史洵玮 Wang Dengfeng;Zhang Guonan;Peng Chunrong;Shi Yu;Shi Xunwei(Gynecologic Oncology Center,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,School of Medicine,University of Electronic Science and Technology of China,Chengdu 610041,China)

机构地区：[1]电子科技大学医学院附属肿瘤医院,四川省肿瘤医院妇科肿瘤中心,成都610041

出　　处：《中华妇产科杂志》2021年第6期385-392,共8页Chinese Journal of Obstetrics and Gynecology

基　　金：四川省科学技术厅重点研发项目(2019YFS0036);四川省干部保健科研课题(川干研2017-801)。

摘　　要：目的对接受新辅助化疗(NACT)+间歇性肿瘤细胞减灭术(IDS)治疗的晚期(Ⅲc~Ⅳ期)卵巢上皮性癌(卵巢癌)患者的预后获益及相关影响因素进行初步探索。方法回顾性分析2014年1月1日至2018年12月31日在四川省肿瘤医院接受手术治疗的Ⅲc~Ⅳ期卵巢癌患者的临床病理资料及随访资料,根据治疗方式不同将患者分为初次肿瘤细胞减灭术(PDS)组(PDS+术后化疗)、NACT+IDS组(NACT+IDS+术后化疗),比较两组患者的预后,并对影响NACT+IDS组患者预后的相关因素进行单因素和多因素分析。结果(1)本研究共纳入216例晚期卵巢癌患者,其年龄为(52.1±8.7)岁,中位随访时间为44.6个月(17.2~80.1个月),中位无进展生存时间(PFS)为11.1个月(8.5~13.8个月),中位总生存时间(OS)为40.0个月(32.7~47.3个月)。(2)216例晚期卵巢癌患者中,PDS组75例,NACT+IDS组141例;与PDS组比较,NACT+IDS组患者的治疗前血清CA125水平(中位数分别为859.4、1371.0 kU/L)、Ⅳ期患者比例[分别为5.3%(4/75)、23.4%(33/144)]、术后无肉眼可见残留灶(R0)切除率[分别为41.3%(31/75)、61.7%(87/141)]均显著增高(P<0.05)。NACT+IDS组患者的中位PFS显著短于PDS组(分别为9.1、15.2个月;χ²=7.014,P=0.008),但两组患者的中位OS比较无显著差异(分别为42.6、38.0个月;χ²=1.325,P=0.250)。(3)单因素分析显示,体质指数(BMI)、手术病理分期、NACT疗效、IDS前血清CA125水平、术后残留灶大小、术后开始化疗时间及化疗方案与NACT+IDS组患者的PFS显著相关(P<0.05);手术病理分期、NACT疗效、IDS前血清CA125水平、术后残留灶大小、术后开始化疗时间及化疗方案与NACT+IDS组患者的OS显著相关(P<0.05)。多因素分析显示,BMI、术后残留灶大小、术后开始化疗时间是影响NACT+IDS组患者PFS的独立因素(P<0.05);手术病理分期、IDS前血清CA125水平、术后残留灶大小是影响NACT+IDS组患者OS的独立因素(P<0.05)。进一步将本研究提示的影�Objective To explore the prognostic factors of patients with advanced epithelial ovarian cancer(EOC)who received neoadjuvant chemotherapy(NACT)followed by interval debulking surgery(IDS).Methods The clinical and pathological data of patients with stageⅢc-ⅣEOC underwent surgical treatment in Sichuan Cancer Center from January 1st,2014 to December 31th,2018 were retrospectively analyzed,and the prognosis was followed up.Results(1)A total of 216 EOC patients were included in the study,whose age was(52.1±8.7)years old,the median follow-up time was 44.6 months(17.2-80.1 months),the median progression free survival(PFS)was 11.1 months(8.5-13.8 months),and the median overall survival(OS)was 40.0 months(32.7-47.3 months).(2)Among 216 patients with advanced EOC,there were 75 cases in the primary debulking surgery(PDS)group and 141 cases in the NACT+IDS group.Compared with the PDS group,the serum CA125 level before treatment(median:859.4 vs 1371.0 kU/L),proportion of stageⅣpatients[5.3%(4/75)vs 23.4%(33/144)]and no visible residual disease(R0)cytoreduction rate in the NACT+IDS group were significantly higher[41.3%(31/75)vs 61.7%(87/144);all P<0.05].The median PFS in the NACT+IDS group was significantly shorter than that of the PDS group(9.1 vs 15.2 months;χ^(2)=7.014,P=0.008),but there was no significant difference in the median OS between the two groups(42.6 vs 38.0 months;χ^(2)=1.325,P=0.250).(3)Univariate analysis showed that body mass index(BMI),preoperative serum CA125 level,surgical-pathological stage,NACT effect,postoperative residual tumor size,time to initiation of postoperative chemotherapy and chemotherapy regimen were significantly correlated with PFS in the NACT+IDS group(all P<0.05);preoperative serum CA125 level,surgical-pathological stage,NACT effect,postoperative residual tumor size,postoperative chemotherapy regimen were significantly related with OS in the NACT+IDS group(all P<0.05).Multivariate analysis showed that BMI,postoperative residual tumor size,time to initiation of postoperative chemot

关 键 词：卵巢肿瘤 化疗 辅助 肿瘤细胞减灭术 预后 

分 类 号：R737.31[医药卫生—肿瘤]