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目的对晚期卵巢上皮性癌手术切净率进行术前评估,以利于新辅助化疗后行中间性肿瘤细胞减灭术,使患者免于不必要的手术。方法回顾性分析2005-2008年在四川省肿瘤医院经手术和病理证实的80例Ⅲ、Ⅳ期上皮性卵巢癌患者术前血清CA125水平,CT或MRI结果及有无腹水从而对理想肿瘤细胞减灭术进行术前评估。14例无法手术的患者进行了新辅助化疗后研究其血清CA125水平对其手术切净率的影响。结果首次手术后进行了理想的肿瘤细胞减灭术者50例,肿瘤大块切除术者16例,14例无法切除者先进行了3个周期新辅助化疗后全部进行了二次手术切除。CA125≤450 kU/L,作为满意肿瘤细胞减灭术的阳性预测值为75%,阴性预测值为40%。12例腹膜弥漫性增厚和有大量腹水存在的患者中,仅4例(33%)实现理想的肿瘤细胞减灭术。结论结合有无腹水、CT或MRI检测结果及血清CA125值可提高理想肿瘤细胞减灭术的预测价值。新辅助化疗有利于控制腹水,提高晚期卵巢上皮性癌的手术切除率,了解肿瘤对化疗方案的敏感性,指导术后辅助化疗方案的选择。
Objective To evaluate the surgical resection rate of advanced epithelial ovarian cancer in order to facilitate the neutrophil chemo-cytoreductive surgery and to prevent the patients from unnecessary surgery. Methods The preoperative serum CA125 level, CT or MRI findings and the presence of ascites in 80 patients with stage Ⅲ and Ⅳ epithelial ovarian cancer confirmed by surgery and pathology from 2005 to 2008 in Sichuan Cancer Hospital were retrospectively analyzed. Surgery for preoperative assessment. Fourteen patients with inoperable conditions underwent neoadjuvant chemotherapy to study the effect of their serum CA125 levels on the rate of surgical resection. Results After the first operation, 50 patients with ideal cytoreductive surgery, 16 patients with tumor mass excision, and 14 patients with unresectable disease were treated with three cycles of neoadjuvant chemotherapy and then all the patients underwent the second surgical resection. CA125 ≤ 450 kU / L, as a satisfactory tumor cytoreductive surgery positive predictive value was 75%, the negative predictive value was 40%. Of the 12 patients with diffuse peritoneal thickening and significant presence of ascites, only 4 (33%) achieved ideal cytoreductive surgery. Conclusion Combined with or without ascites, CT or MRI test results and serum CA125 values can improve the predictive value of ideal tumor cytoreductive surgery. Neoadjuvant chemotherapy is beneficial to control ascites, improve the surgical resection rate of advanced ovarian epithelial carcinoma, understand the sensitivity of tumor to chemotherapy regimen and guide the choice of postoperative adjuvant chemotherapy regimen.