论文部分内容阅读
目的探讨晚期上皮性卵巢癌患者采用新辅助化疗(NACT)治疗的可行性,评价NACT效果对患者手术、生存期的影响及NACT的预后影响因素。方法回顾性分析2005年1月至2010年12月在本院治疗的国际妇产科联盟(FIGO)分期Ⅲc~Ⅳ期的上皮性卵巢癌患者85例,根据接受初次肿瘤细胞减灭术(PDS)治疗与否,分为A、B两组。其中A组(n=40)行PDS+化疗,B组(n=45)先接受NACT后再行肿瘤细胞减灭术(IDS)。比较NACT前后患者腹水、血清CA125和肿块大小变化,观察NACT疗效;比较A、B两组在治疗有效率、复发率、满意肿瘤细胞减灭术成功率、术中失血量、输血量、手术时间、住院时间、无进展生存期(PFS)和总生存期(OS)等方面的差异,并比较B组不同疗程对手术、生存期的影响以及预后影响因素。结果 B组患者接受NACT后,合并大量腹水的病例数由30例降至9例,血清CA125水平由(2 085.4±2 407.3)U·mL~(-1)降至(249.8±138.4)U·mL~(-1)(P<0.001),肿瘤最大直径由原来的(6.2±2.9)cm减小至(5.0±3.4)cm(P<0.001)。B组行满意肿瘤细胞减灭术的成功率较A组高(78%vs.55%,P=0.011);手术时间(122.0±35.5)min vs.(130.5±24.0)min,P=0.002)和术中失血量(348.9±291.4)mL vs.(378.8±148.0)mL,P=0.001 8)少于A组;两组输血情况、术后排气时间、住院时间、术后并发症、PFS、OS无显著差异。接受NACT疗程<4次的患者生存期优于≥4次的患者(37个月vs.26个月,P=0.029)。结论 NACT是晚期卵巢癌患者安全可行的治疗方法,能提高满意肿瘤细胞减灭术的成功率、减少术中失血、缩短手术时间,但对患者的PFS和OS无显著影响。满意肿瘤细胞减灭术和CA125半衰期是影响NACT患者预后的独立因素。
Objective To investigate the feasibility of neoadjuvant chemotherapy (NACT) in patients with advanced epithelial ovarian cancer and evaluate the effect of NACT on the operation and survival of patients and the prognostic factors of NACT. Methods A retrospective analysis of 85 patients with epithelial ovarian cancer from the International Union of Gynecology and Obstetrics (FIGO) stage Ⅲc-Ⅳ in our hospital from January 2005 to December 2010 was performed retrospectively. According to the results of primary tumor cytoreductive surgery (PDS ) Treatment or not, divided into A, B two groups. Among them, group A (n = 40) underwent PDS + chemotherapy and group B (n = 45) received NACT before tumor cytoreductive surgery (IDS). Compare the changes of ascites, serum CA125 and tumor size before and after NACT, and observe the effect of NACT. Compare the success rate of treatment, recurrence, success rate of tumor cytoreduction, blood loss, blood transfusion, operation time , Length of hospital stay, progression-free survival (PFS) and overall survival (OS). The effects of different courses of treatment on the operation and survival and the prognostic factors were compared. Results After receiving NACT, the number of cases with large amount of ascites in group B decreased from 30 to 9, and the level of serum CA125 decreased from (2 085.4 ± 2 407.3) U · mL -1 to (249.8 ± 138.4) U · mL ~ (-1) (P <0.001). The maximum tumor diameter decreased from (6.2 ± 2.9) cm to (5.0 ± 3.4) cm (P <0.001). The successful rate of tumor cytoreductive surgery in group B was higher than that in group A (78% vs.55%, P = 0.011); the operative time was (122.0 ± 35.5) min vs. (130.5 ± 24.0) min, P = 0.002) And blood loss in operation (348.9 ± 291.4 mL vs 378.8 ± 148.0 mL, P = 0.001 8) were less in group A than in group A. The blood transfusion, postoperative exhaust time, hospital stay, postoperative complications, PFS , OS no significant difference. Patients who received NACT for less than 4 times had better survival than 4 times (37 months versus 22.6 months, P = 0.029). Conclusion NACT is a safe and feasible treatment for patients with advanced ovarian cancer, which can improve the success rate of satisfactory cytoreductive surgery, reduce blood loss and shorten the operation time, but have no significant effect on PFS and OS. Satisfactory tumor cytoreductive surgery and CA125 half-life are independent prognostic factors in patients with NACT.