复发性卵巢癌二线化疗临床价值的循证评价

Evidence-based Evaluating on Clinical Value of Second-line Chemotherapy for Ovarian Cancer

目的评价复发性卵巢上皮癌化疗的临床价值。方法采用循证评价的方法,对1999年1月至2003年12月国内外公开发表的有关复发性卵巢上皮癌患者化疗对其生存期影响的所有文献进行复习,对符合循证系统评价的文献结果进行分析,从而评价化疗对复发性卵巢上皮癌患者生存期的影响。结果符合纳入标准的共14篇文献,循证评价结果显示:①铂类敏感的复发性卵巢癌中,接受了铂类或以铂类药物为基础的二线化疗者的总反应率为58.0%,中位反应率为57.0%。而接受了非铂类药物二线化疗者的总反应率为24.5%,中位反应率为24.2%。两者相比较,均有显著性差异,P<0.05。②铂类耐药的复发性卵巢癌中,接受铂类或以铂类药物为基础的二线化疗的总反应率为52.6%,中位反应率为56.3%。而接受非铂类药物二线化疗的总反应率为19.2%,中位反应率为48.67%。两者相比较,均有显著性差异,P<0.05。③铂类耐药型复发性卵巢癌患者选用铂类药物二线化疗的中位生存期为20个月,而用非铂类药二线化疗的中位生存期为14.5个月,两者相比较,有显著性差异,P<0.05。结论二线化疗方案的选择及预后与对铂类化疗敏感性有关。复发性卵巢上皮性癌二线化疗应遵循个性化原则。为了改善复发性卵巢上皮性癌的预后和提高生存率,最佳的治疗方法仍需要进一步研究。

Objective To evaluate clinical value of second-line chemotherapy for ovarian cancer. Methods All literature between 1999 and 2003 about the effectiveness of second-line chemotherapy for survival in patients with recurrent epithelial ovarian cancer was reviewed. And evidence-based evaluating was used to evaluate strictly all the studies that can be analyzed by evidencebased evaluating systematic review. Results ①In platinum-sensltive responder patients with recurrent epithelial ovarian cancer,the total responded rate and median responded rate to platinum drug are 58 %,6 and 57%,6 respectively, but these are only 24.5%,6 and 24.2% respectively for non- platinum drug. There are significant differences（P〈0.05）.②In platinum-resistance responder patients with recurrent epithelial ovarian cancer, the total responded rate and median responded rate to platinum drug are 52.6 % and 56.3 %, but these are only 19.2 % and 48.67 % respectively for non- platinum drug. There are significant differences （P〈0.05）.③In platinum-resistance responder patients with recurrent epithelial ovarian cancer, the median survival rate for treatment with platinum drug was 20 month,but it for treatment with non-platinum drug was 14.5 month.Conclusion The evidenced-based research shows that the choice of chemotherapeutic agents and the prognosis depend directly on whether the patient is a platinum-sensitive responder. The treatment of each patient should be individualized depending on the cumulative toxicities and performance status.