铂类敏感型复发性卵巢癌不同治疗方案疗效比较研究  

Comparative Study on the Efficacy of Different Treatment Schemes for Platinum-Sensitive Recurrent Ovarian Cancer

作　　者：赵冰冰[1] 李倩 李力[1] Zhao Bingbing;Li Qian;Li Li(Department of Gynaecology,Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor,Ministry of Education,Cancer Hospital Affiliated to Guangxi Medical University,Nanning 530022,Guangxi Zhuang Autonomous Region,China)

机构地区：[1]广西医科大学附属肿瘤医院妇科,广西区域性高发肿瘤早期防治研究教育部重点实验室,南宁530022

出　　处：《肿瘤预防与治疗》2024年第5期393-404,共12页Journal of Cancer Control And Treatment

基　　金：广西自然科学基金(编号:2023GXNSFAA026216);广西科学研究与技术开发计划(编号:桂科攻14124004-1-24)。

摘　　要：目的:通过对广西医科大学附属肿瘤医院132例铂类敏感型复发性卵巢癌(platinum-sensitive recurrent ovarian cancer, PSROC)进行回顾性病例分析,研究不同临床特征对PSROC患者的总生存期(overall survival, OS)的影响,探讨影响PSROC患者生存情况的因素以及不同治疗方案对PSROC患者的预后影响,从而优化复发型卵巢癌的治疗。方法:收集2010年7月至2018年8月广西医科大学附属肿瘤医院现有电子病历数据132例PSROC患者的临床资料,包括患者复发年龄、FIGO分期、组织病理类型、无铂治疗间期(platinum-free intervals, PFI)、复发时CA125值、复发病灶、腹水这7个因素,探讨PSROC患者生存情况的影响因素并构建预后预测模型。结果:单因素分析表明:PFI、复发时CA125值、复发病灶、腹水与PSROC患者OS相关(P<0.05);复发年龄、FIGO分期、组织病理类型与OS无关(P>0.05)。COX多因素分析表明,PFI、复发时CA125值和复发病灶是PSROC患者预后的独立危险因素(P<0.05)。预后预测模型列线图可用于预测PSROC患者不同时间生存概率。本组PSROC患者随访时间2至108个月,中位随访时间33.5个月。终点分析显示:(1)中位OS在二次肿瘤细胞减灭术(secondary cytoreductive surgery, SCS)组和单纯化疗组分别为51.0个月vs 29.0个月(HR=0.45,95%CI:0.27~0.77,P=0.003),SCS组中位OS延长了22个月,差异有统计学意义(P<0.05);(2)中位OS在肿瘤残余病灶<1 cm组和肿瘤残留病灶≥1 cm组分别为55.0 vs 36.0个月(HR=0.40,95%CI:0.18~0.89,P=0.024),肿瘤残余病灶<1 cm组中位OS延长了19个月,差异有统计学意义(P<0.05);(3)中位OS在以铂类为基础的二次新辅助化疗(secondary neoadjuvant chemotherapy, SNACT)+SCS组和直接行SCS组分别为38.0个月vs 56.0个月(HR=2.02,95%CI:0.95~4.29,P=0.066),两组间差异无统计学意义;(4)中位OS在含顺铂/卡铂为主的方案(常规化疗组)化疗与其他铂类为主方案化疗疗效分别为49.0个月vs 30.5个月(HR=0.Objective:Through retrospective case analysis of 132 platinum-sensitive recurrent ovarian cancer(PSROC)cases in the Cancer Hospital Affiliated to Guangxi Medical University,this study aimed to investigate the effects of different clinical characteristics on the overall survival(OS)of PSROC patients,explore the factors affecting the survival of PSROC patients and the impact of different treatment options on the prognosis of PSROC patients,so as to optimize the treatment of recurrent ovarian cancer.Methods:The clinical data,including relapse age,FIGO stage,histopathological type,platinum-free intervals(PFI),CA125 at recurrence,recurrent lesions and ascites,of 132 PSROC patients with electronic medical re-cords from the Cancer Hospital Affiliated to Guangxi Medical University from July 2010 to August 2018 were collected to ex-plore the factors affecting the survival of PSROC patients and construct a prognostic prediction model.Results:Univariate a-nalysis showed that PFI,CA125 at recurrence,recurrent lesions and ascites were correlated to OS in PSROC patients(P<0.05);relapse age,FIGO stage and histopathological type were not correlated to OS(P>0.05).COX multivariate analysis showed that PFI,CA125 at recurrence and recurrent lesions are independent risk factors for the prognosis of PSROC patients(P<0.05).The nomogram of the prognosis prediction model can be used to predict the survival probability of PSROC pa-tients at different times.The follow-up time of PSROC patients in this study ranged from 2 to 108 months,with a median fol-low-up time of 33.5 months.The median OS were 51.0 and 29.0 months in the secondary cytoreductive surgery(SCS)group and chemotherapy alone group(HR=0.45,95%CI:0.27~0.77,P=0.003);the median OS in the former was 22 months longer than that in the latter,and the difference was statistically significant(P<0.05).The median OS were 55.0 and 36.0 months in the residual tumor lesion<1 cm group and the residual tumor lesion≥1 cm group(HR=0.40,95%CI:0.18~0.89,P=0.024);the median OS in the former was

关 键 词：铂类敏感型复发性卵巢癌 二次肿瘤细胞减灭术 二次新辅助化疗 列线图 

分 类 号：R737.31[医药卫生—肿瘤] R730.53[医药卫生—临床医学] R730.56