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目的:探讨二次肿瘤细胞减灭术对铂类敏感的复发性卵巢上皮癌治疗的临床意义。方法:回顾性分析我院于2002年1月至2012年12月收治的115例铂类敏感的复发性卵巢上皮癌患者的临床及随访资料。结果:在115例铂类敏感的复发性卵巢上皮癌中,66例接受了二次肿瘤细胞减灭术(手术组),术后辅以铂类为基础的化疗。49例患者只接受了以铂类为基础的化疗(对照组)。两组患者肿瘤病理分型无统计学差异(P=0.485)。与对照组相比,手术组FIGO分期IV期患者的比例少(15.2%VS 34.7%,P=0.014),低分化患者的比例少(71.2%VS 91.8%,P=0.024),多发复发病灶患者的比例少(28.3%VS 49.0%,P=0.027)。平均随访30.2个月(6-48个月),Kaplan-Meier生存分析显示,手术组与对照组患者的中位生存期分别为35.0个月和27.0个月,差异有统计学差异(Log rank 7.9,P=0.005)。多因素Cox回归分析显示,校正了年龄、肿瘤病理类型、病理分级及FIGO分期后,不同治疗方案是复发上皮性卵巢癌患者远期生存率的独立影响因素。结论:二次肿瘤细胞减灭术可以改善铂类敏感的复发性卵巢上皮癌患者的临床预后。
Objective: To investigate the clinical significance of secondary cytoreductive surgery in the treatment of platinum-sensitive recurrent epithelial ovarian cancer. Methods: A retrospective analysis of our hospital from January 2002 to December 2012 admitted to 115 cases of platinum-sensitive recurrent epithelial ovarian cancer patients and follow-up data. RESULTS: Of the 115 platinum-sensitive recurrent epithelial ovarian cancers, 66 received cytoreductive surgery (surgery group) followed by platinum-based chemotherapy. Forty-nine patients received only platinum-based chemotherapy (control group). There was no significant difference in tumor pathological type between the two groups (P = 0.485). Compared with the control group, the proportion of stage IV patients with FIGO staging was significantly lower in the surgery group (15.2% vs. 34.7%, P = 0.014), less in poorly differentiated patients (71.2% vs 91.8%, P = 0.024) (28.3% vs 49.0%, P = 0.027). With a mean follow-up of 30.2 months (range, 6-48 months), Kaplan-Meier survival analysis showed that the median survival time was 35.0 months and 27.0 months in the surgery group and the control group, respectively, with a statistically significant difference (Log rank 7.9 , P = 0.005). Multivariate Cox regression analysis showed that different treatment regimens were independent factors of long-term survival in patients with recurrent epithelial ovarian cancer after adjusting for age, tumor pathology, pathological grade and FIGO staging. Conclusions: Secondary cytoreductive surgery can improve the clinical prognosis of patients with platinum-sensitive recurrent epithelial ovarian cancer.