ⅢC期卵巢上皮癌术后一线化疗用药剂量对预后的影响

Impact of Dose Delivery of Postoperative First-line Chemotherapy on Prognosis of Stage ⅢC Epithelial Ovarian Carcinoma

背景与目的:化疗是治疗晚期卵巢癌必不可少的手段,选择合适的化疗药物和应用合适的化疗剂量是合理用药的两个方面,用药剂量对生存的影响一直有争议。本文拟探讨卵巢癌术后一线化疗用药剂量对预后的影响。方法:回顾性分析术后采用含铂类药物进行辅助化疗的47例ⅢC期卵巢上皮癌患者的临床资料,计算各种药物的相对总剂量(cumulativedose,CD)和相对剂量强度(doseintensity,DI),分析用药剂量对无进展生存时间(progression鄄freesurvival,PFS)和总生存时间(overallsurvival,OS)的影响。结果:总体中位CD为0.76,中位DI为0.53。顺铂中位CD为0.78,中位DI为0.57;紫杉醇中位CD为0.81,中位DI为0.51。应用Kaplan鄄Meier曲线和log鄄rank检验行单因素分析显示,各剂量指标对整个群体的PFS和OS都没有影响。分组分析显示,对于顺铂联合非紫杉醇组总体CD、顺铂CD和顺铂DI越大,PFS越长(P值分别为0.01、0.00和0.01),OS越长(P值分别为0.01、0.00和0.01);而各剂量指标对顺铂联合紫杉醇组的预后均没有影响。残留大病灶组(>2cm)顺铂DI越大,PFS越长(P=0.01),总体CD和顺铂DI越大,OS越长(P=0.04和0.01);残留小病灶组(残留病灶≤2cm)各剂量指标对PFS、OS均无显著性影响。多因素分析显示残留病灶大小是唯一的预后影响因素。结论:对术后残留病灶较大(>2cm)或采用非紫杉醇方案化疗的ⅢC期卵巢癌患者,用药剂量可能会影响生存时间。残留病灶大小是影响预后的唯一独立因素。

BACKGROUND ＆ OBJECTIVE. Chemotherapy, which includes selecting appropriate drugs and suitable dose, is necessary to advanced ovarian carcinoma. Whether dose delivery affects prognosis of ovarian cancer is controversial. This study was to investigate the impact of dose delivery of postoperative first-line chemotherapy on prognosis of stage Ⅲ C epithelial ovarian carcinoma. METHODS. Clinical data of 47 stage Ⅲ C epithelial ovarian carcinoma patients, treated with cisplatin-based adjuvant first-line chemotherapy, were retrospectively analyzed. The relative cumulative dose （CD） and dose intensity （DI） were calculated for each drug and for all drugs combined （namely overall CD and overall DI）. The impact of dose delivery on progression-free survival （PFS） and overall survival （OS） was analyzed. RESULTS： Median overall CD was 0.76, and median overall DI was 0.53; the midian CD of cisplatin was 0.78, and the midian DI of cisplatin was 0.57; the midian CD of paclitaxel was 0.81, and the midian DI of paclitaxel was 0.51. Dose delivery had no impact on PFS and OS of the patients.However, in non-paclitaxel chemotherapy subgroup, the higher overall CD,or CD for cisplatin, or DI for cisplatin, the longer PFS （P=0.01, P=0.03, P=0.01） and OS （P=0.01, P=0.04, P=0.01）; in paclitaxel chemotherapy subgroup, dose delivery had no impact on PFS and OS. In suboptimal surgery subgroup （residual disease of 〉 2 cm）, the higher DI for cisplatin,the longer PFS; the higher overall CD, or DI for cisplatin, the longer OS. In optimal surgery subgroup （residual disease of ≤2 cm）, dose delivery had no impact on PFS and OS. Residual disease was the only independent prognostic factor of epithelial ovarian carcinoma. CONCLUSIONS. The dose delivery below standard level may influence survival of the patients with residual disease of 〉 2 cm or treated by non-paclitaxel chemotherapy. The diameter of residual disease is the independent prognostic factor of epithelial ovarian carcinoma.