多次复发行3次及以上肿瘤细胞减灭术的卵巢上皮性癌患者预后及其影响因素分析  

Analysis of prognosis and associated factors in multiple recurrent epithelial ovarian cancer with three times or more cytoreductive surgeries

作　　者：邹若瑶 袁蕾 陈默 尧良清 Zou Ruoyao;Yuan Lei;Chen Mo;Yao Liangqing(Department of Gynecologic Oncology,Obstetrics and Gynecology Hospital of Fudan University,Shanghai 200011,China)

机构地区：[1]复旦大学附属妇产科医院妇科肿瘤科,上海200011

出　　处：《中华妇产科杂志》2023年第3期198-206,共9页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的探讨多次(≥2次)复发行3次及以上肿瘤细胞减灭术的卵巢上皮性癌(卵巢癌)患者的预后,并分析预后影响因素。方法收集2015年1月1日至2022年1月30日复旦大学附属妇产科医院收治的多次复发行3次及以上肿瘤细胞减灭术的23例卵巢癌患者的临床病理资料及随访资料,回顾性分析其手术切除程度、复发转移部位、术后并发症及预后,并采用单因素Cox比例风险模型对影响患者预后的相关因素进行分析。结果 (1)23例多次复发的卵巢癌患者的中位年龄为48岁(44~55)岁;其中,行三次肿瘤细胞减灭术(TCS)者18例,行四次肿瘤细胞减灭术者2例,行五次肿瘤细胞减灭术者2例,行六次肿瘤细胞减灭术者1例。23例多次复发的卵巢癌患者中,以浆液性癌[21例(91%,21/23)]、晚期[Ⅲ~Ⅳ期;16例(70%,16/23)]、高分化[19例(83%,19/23)]为主。(2)基于初次肿瘤细胞减灭术(PDS)达到满意减瘤(残留灶最大径<1 cm)、二次肿瘤细胞减灭术(SCS)达到无肉眼可见残留灶(R0)的前提下,行3次及以上肿瘤细胞减灭术共32例次,多次复发时最大肿瘤的最大径为10.0 cm,以多发性复发转移为主[20例次(62%,20/32)];3次及以上肿瘤细胞减灭术的R0率为88%(28/32);术后并发症发生率为47%(15/32),其中Ⅲ级及以上并发症仅占3%(1/32)。TCS后的中位随访时间为31.1个月(20.6~43.9个月);23例行TCS的患者中,20例(87%,20/23)TCS后复发,其中8例(35%,8/23)最终因卵巢癌死亡;TCS达到R0的患者22例,其术后3年总生存率为57.6%,而1例残留灶≥1 cm的患者于TCS后9.2个月死亡。(3)单因素分析显示,年龄、PDS与SCS间隔时间、SCS与TCS间隔时间、TCS时有无转移性腹膜癌与TCS后的无进展生存时间均显著相关(P均<0.05);SCS后无治疗间隔时间(TFI)、SCS与TCS间隔时间、TCS时有无腹水、铂敏感性与TCS后的疾病特异性生存时间均显著相关(P均<0.05)。结论对有望达到R0且并发症可控的多次复发卵巢癌患Objective To explore the prognosis of epithelial ovarian cancer patients with multiple recurrences(≥2 times)who underwent three times or more cytoreductive surgeries,and to analyze the factors associated with prognosis.Methods The clinicopathological data and follow-up data of 23 patients with ovarian cancer admitted to the Obstetrics and Gynecology Hospital of Fudan University from January 1,2015 to January 30,2022 with three times or more cytoreductive surgeries were collected.The degree of surgical resection,site of recurrence and metastasis,postoperative complications,and prognosis were retrospectively analyzed.The univariate Cox proportional hazards model was performed to identify the variables associated with survival.Results(1)The median age of 23 patients with multiple recurrent ovarian cancer was 48 years old(44-55 years).Among them,18 cases underwent tertiary cytoreductive surgery(TCS),2 cases underwent quaternary cytoreductive surgery,2 cases underwent quinary cytoreductive surgery,and 1 case underwent senary cytoreductive surgery.Among the 23 patients with multiple recurrent ovarian cancer,21 cases(91%,21/23)had serous carcinoma,16 cases(70%,16/23)had advanced stage(stageⅢ-Ⅳ),and 19 cases(83%,19/23)had high differentiation.(2)Based on the premise that satisfactory cytoreduction was achieved by primary debulking surgery(PDS)and no visible residual disease(R0)was achieved by secondary cytoreductive surgery(SCS),the maximum diameter of the recurrent tumors was up to 10.0 cm and 62%(20/32)of patients with multiple metastatic sites.The R0 rate for three times or more cytoreductive surgeries(32 times in total)reached 88%(28/32),with a postoperative complication rate of 47%(15/32),and only 3%(1/32)for gradeⅢor above.During a median follow-up time of 31.1 months(20.6-43.9 months)after TCS,20 patients(87%,20/23)recurred after TCS,and 8 patients(35%,8/23)eventually died of ovarian cancer.Among them,the three-year postoperative survival rate of 22 patients with R0 was 57.6%,and the patient with residual

关 键 词：卵巢上皮癌 肿瘤复发 局部 多次肿瘤细胞减灭术 预后 

分 类 号：R737.31[医药卫生—肿瘤]