Ⅲ期卵巢癌减灭术后腹腔残瘤对患者预后的影响  

The significance of abdominal residue after primary cytoreductive surgery forst age Ⅲ ovarian cancer

作　　者：汤洁[1] 蔡树模[1] 臧荣余[1] 王华英[1] 

机构地区：[1]复旦大学附属肿瘤医院妇科,上海200032

出　　处：《中国癌症杂志》2004年第1期31-35,共5页China Oncology

摘　　要：目的 :分析Ⅲ期卵巢癌减灭术后腹腔残瘤对患者预后的影响因素。方法 :1990年 11月～ 1996年 11月本院行初次肿瘤细胞减灭术的Ⅲ期卵巢癌 57例 ,平均年龄 51.9岁 (2 3～ 74岁 )。术后肉眼无残瘤 9例 ,腹腔残瘤 7例 ,盆腔残瘤 4例 ,腹盆腔均有残瘤 3 7例 ,残瘤≤ 1cm的 2 0例。术前有 3 0例接受化疗 ,术后腹腔化疗 3 6例 ,平均 3次 ,术后铂类为主静脉化疗 46例 ,平均 4次。治疗后临床完全缓解 3 2例 (56.1% )。结果 :平均随访 2 9.1月(0 .3～ 10 9.1月 ) ,Ⅲ期卵巢癌的一年、二年、三年、四年、五年生存率分别为 79.82 % ,57.59% ,49.0 6% ,3 9.93 % ,2 3 .41%。单因素分析发现分期 (P =0 .0 2 83 )、残瘤大小 (P =0 .0 0 41)、腹腔残瘤 (P =0 0 3 62 )、手术方式 (P =0 0 3 3 7)、术后腹腔化疗 (P =0 .0 469)等因素均影响患者术后生存。多因素分析结果提示残瘤大小 (P =0 .0 0 2 5)、术后腹腔化疗 (P =0 .0 3 2 3 )和静脉化疗 (P =0 .0 2 97)是影响患者生存的独立的预后因素。术后腹腔内肉眼无残瘤者的存活率高于腹腔有残留者 ,中位生存期分别为 58.0月和 2 2 .7月 (P =0 .0 3 62 ) ,三年、五年生存率分别为 83 .64%vs 3 7.60 % ,2 9.57%vs 2 1.0 5%。对于术后腹腔内肉眼有残瘤者 ,腹腔内残瘤小者生存?Purpose:To evaluate the significance of abdominal residue after primary cytoreductive su rgery for stage Ⅲ ovarian cancer.Methods:From Nov 1990 to Nov 1996, 57 patients with stage Ⅲ ovarian cancer who underwen t primary cytoreduction in our hospital and their residual disease were analyzed , with mean age of 51.9 (23～74). 20 patients achieved optimal cytoreduction (th e largest residual tumor ≤ 1cm). 9 patients had no gross residual tumor after s urgery, 37 cases had residual disease both in the abdomen and pelvis. Abdominal residual disease was found in 7 cases and pelvic residual disease in 4 cases. 30 cases were given chemotherapy before surgery. After primary surgery, 36 patient s received a mean of 3 courses of intraperitoneal chemotherapy and 46 patients were treated with a mean of 4 cycles of platinum-based intravenous chemotherapy . Complete remission were achieved in 32 cases (56.1%).Results:With a mean follow-up of 29.1 months (0.3～109.1months), 1-5 year survival rat es were 79.82%, 57.59%, 49.06%, 39.93%, 23.41%, respectively. Univariate analysi s indicated stage (P=0.0283), size of residual disease (P=0.0041), resid ue in the abdomen (P=0.0362), type of surgery (P=0.0337) and intraperito neal chemotherapy after surgery (P=0.0469) influenced survival. Multivariate analysis suggested that size of residual disease (P=0.0025), intraperiton eal chemotherapy (P=0.0323) and intravenous chemotherapy (P=0.0297)aft er surgery were independent prognostic factors of survival. Those patients who h ad no macroscopic residual lesion in the abdomen after cytoreducion had a better survival, with estimated median survival of 58.0 months vs 22.7 months for pati ents with abdominal residue (P=0.0362), with 3-year, 5-year survival rate of 83.64% vs 37.60% and 29.57% vs 21.05%, respectively. Residual disease in the pelvis did not affect the survival (P=0.2782). For patients with abdominal r esidue after surgery, optimal abdominal cytoreduction predicted increased surviv al (P=0.0319), while optimal pelvic cytored

关 键 词：卵巢癌 细胞减灭术 腹腔残余肿瘤 预后 

分 类 号：R737.31[医药卫生—肿瘤]