卵巢上皮性癌手术加铂类药物联合化疗疗效的相关临床病理因素分析

The Rapeutic Factors Analysis in Surgry Plus Platinum Chemotherapy Curative Effect of Epithelial Ovarian Carcinoma

目的:探讨影响卵巢上皮性癌手术加铂类药物联合化疗疗效的相关临床病理因素。方法:回顾性分析534例初治行手术加铂类药物联合化疗的卵巢上皮性癌患者,并随访预后。用Logrank test检验及Cox模型作临床病理相关因素分析。结果:1手术病理分期Ⅰ、Ⅱ期患者的中位总生存期(OS)及中位无进展生存期(PFS)高于Ⅲ、Ⅳ期,Ⅲ期患者的中位OS及中位PFS高于Ⅳ期(P<0.05)。2组织学分级高分化癌患者中位OS及中位PFS均高于中、低分化患者(P<0.01)。3达理想肿瘤细胞减灭患者中位OS及中位PFS显著高于肿瘤细胞减灭不理想患者(P<0.01)。4不管是否达到理想减瘤,大网膜切除者中位OS及中位PFS高于大网膜未切除者(P<0.05)。5达到理想减瘤患者中,腹膜后淋巴结未转移者中位OS及中位PFS高于淋巴结转移者(P<0.01),肠管受累未切除者中位OS及中位PFS高于肠管切除者(P<0.05),横膈未受累患者的中位OS及中位PFS高于横膈受累者(P<0.05)。6化疗方案TC及TP有相似的疗效,但两组化疗方案的中位OS及中位PFS均高于PC化疗组,化疗疗程<6次组其中位OS及中位PFS低于化疗疗程≥6次组,差异均有统计学意义(P<0.05)。7经Cox模型多因素分析,手术病理分期、组织学分级、肿瘤细胞减瘤理想程度、大网膜切除是影响手术疗效的独立因素(P<0.01)。结论:影响卵巢上皮性癌患者手术加铂类药物联合化疗预后决定于组织学分级、手术病理分期、大网膜切除、肿瘤细胞减瘤理想程度。在大的诊治原则下,根据患者的具体病情尽量做到个体化治疗。

Objective：To study affect clinical pathological factors in surgry plus platinum chemotherapy curative effect of epithelial ovarian carcinoma.Methods：Related clinical pathologic factors of 534 cases in ovarian epithelial carcinoma with surgry plus platinum chemotherapy were analyzed retrospectively and the prognosis was investigated by following up.The univariate Log Rank test and multivariates Cox model were used in survival analysis.Results：1The median overall survival and median progress free survival of Ⅰ,Ⅱ stage patients were better than Ⅲ,Ⅳstage,the prognosis ofⅢ stage patients was better than Ⅳ stage（P〈0.0 5）.2The median overall survival and median progress free survival in High differentiation carcinoma patients reached ideal cytoreductive surgery was significantly longer than the middle and low differentiation patients（P〈0.01）.3The median overall survival and median progress free survival of patients achieved ideal cytoreductive surgery were better than those who were not（P〈0.01）.4Whether achieve ideal cytoreductive surgery or not,the median overall survival and median progress free survival of patients removed greater omentum were better than that not removed,the difference was statistically significant（P〈0.05）.5In those patients who were achieved ideal cytoreductive surgery,the median overall survival and median progress free survival of patients without retroperitoneal lymph node metastasis was better than those of metastasis,the median overall survival and median progress free survival of patients whose intestine metastasis without resection was better than those resected,the median overall survival and median progress free survival of patients without diaphragmatic metastasis was better than the median overall survival of metastasis,the difference was statistically significant（P〈0.05）.6Chemotherapy regimens TC and TP had similar curative effect,but the two groups of chemotherapy regimens of median overall survival and median progress free survival are longer than the PC chemotherapy group,the median overall survival and median progress free survival of chemotherapy treatment group less than 6times are shorter than the median overall survival more than 6times,the difference were statistically significant（P〈0.05）.7In multivariates analysis of Cox model,surgical pathologic stage,histological grade,ideal degree of cytoreductive surgery,greater omentum resection were the independent factors influencing the surgey effect（P〈0.01）.Conclusions：The prognosis of patients with ovarian epithelial ovarian cancer combined with platinum chemotherapy is decided by the degree of histological grade,surgical stage,resection of the tumor,tumor cell reduction.According to the patient＇s specific condition as far as possible to achieve individual treatment.