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目的研究IV期上皮性卵巢癌的临床病理特征及预后影响因素,为Ⅳ期上皮性卵巢癌的治疗提供参考。方法回顾性分析1997年1月至2009年12月中山大学肿瘤医院收治的经手术及病理确诊为Ⅳ期上皮性卵巢癌患者共64例的临床病例资料及随访资料,其中32例患者直接行手术治疗(PDS),32例患者先行新辅助化疗(NACT),再接受中间性肿瘤细胞术(IDS)。分析各临床病理因素及治疗方法对预后的影响。结果未发现年龄、治疗前CA125水平、病理类型、肿瘤分化程度、原发肿瘤大小、转移类型、是否新辅助化疗及手术满意程度等与总生存时间相关(P>0.05)。仅因胸水细胞学阳性诊断为Ⅳ期的患者行新辅助化疗+中间性肿瘤细胞减灭术者总生存时间中位数较直接行手术治疗者长39个月(P=0.020)。新辅助化疗与手术的满意程度相关(P<0.001)。结论在经过评估无法行满意的肿瘤减灭术的患者,新辅助化疗+中间性肿瘤细胞减灭术可考虑成为Ⅳ期卵巢癌治疗的选择之一。
Objective To investigate the clinicopathological features and prognostic factors of stage IV epithelial ovarian cancer and provide references for the treatment of stage IV epithelial ovarian cancer. Methods The clinical data and follow-up data of 64 cases with stage Ⅳ epithelial ovarian cancer who were diagnosed by surgery and pathology from January 1997 to December 2009 in Cancer Hospital of Sun Yat-sen University from January 1997 to December 2009 were retrospectively analyzed. Among them, 32 cases underwent direct surgery (PDS), 32 patients received neoadjuvant chemotherapy (NACT) followed by intermediate tumor cell surgery (IDS). Analysis of the clinical and pathological factors and treatment of prognosis. Results The age, CA125 level before treatment, pathological type, tumor differentiation degree, primary tumor size, type of metastasis, neoadjuvant chemotherapy and satisfaction with operation were related to the overall survival time (P> 0.05). The median overall survival time of neoadjuvant chemotherapy + intermediate cytoreductive surgery alone was 39 months (P = 0.020) longer than that of patients undergoing direct surgery because of pleural fluid cytology positive diagnosis of stage IV. Neoadjuvant chemotherapy was associated with satisfaction with surgery (P <0.001). Conclusions Neoadjuvant chemotherapy + intermediate cytoreductive surgery may be considered as an option for the treatment of stage IV ovarian cancer in patients who have not been evaluated for satisfactory tumor ablation.