晚期卵巢上皮性癌近20年的预后变化

Prognosis change of advanced epithelial ovarian cancer in recent 20 years

目的总结近20年我院晚期卵巢上皮性癌的预后状况,并对改善预后的因素进行分析。方法回顾分析1980年1月至1999年12月治疗的180例晚期卵巢癌患者的临床资料,按治疗时间分为两组,1989年12月31日以前的58例为第I组,以后的122例为第II组,对两组的临床资料包括预后进行比较,并分析影响预后的因素。结果第I组2年、5年生存率分别为18.9%、3.5%,第II组分别为57.7%、31.9%,第II组的预后明显好于第1组。单因素分析显示IIIa、IIIb期较IIIc期和IV期预后好;残余瘤≤2cm者比残余瘤>2cm者预后好;术后联合化疗≥6个疗程者较<6个疗程者预后好;TP方案或加用其他二线药物化疗者较CAP或CP方案化疗者预后好,两者均较未化疗或单一药物或非规范的联合化疗者预后好。COX逐步回归多因素分析显示,仅残余瘤大小及化疗疗程数对预后有影响。结论晚期卵巢上皮性癌的预后近10年来得到了明显改善,肿瘤细胞减灭术、CAP或TP方案6个或以上疗程的化疗有助于提高晚期卵巢癌患者的5年生存率。

Objective To evaluate the prognosis change of advanced epithelial ovarian cancer in recent 20 years and to analyze the factors associated with prognosis improvement. Methods One hundred and eighty patients with advanced epithelial ovarian cancer treated in our hospital from January 1980 to December 1999 were analyzed retrospectively. They were divided into two groups based on their operation time. Fifty-eight patients who were operated before Dec.31, 1989 were included in the first group and the other 122 patients in the second group. The clinicopathological features in- cluding survival were compared and factors associated with survival were identified. Results The overall 2-and 5-year survival rate were 18.9% and 3.5% in the first group respectively and were 57.7% and 31.9% in the second group respectively. The prognosis of the patients in the second group was better than that in the first group. Univariate analysis revealed that patients with stage Ⅲa and Ⅲb, residual tumor size≤2cm, 6 or more cycles of chemotherapy and TP, CP or CAP regimen were associated with better prognosis. Cox regression analysis identified only residual tumor size and chemotherapeutic courses were independent prognostic factors. Conclusions The prognosis of the patients with advanced ovarian cancer has been improved significantly in recent 10 years, optimal cytoreductive surgery and 6 or more cycles chemotherapy are necessary to improve the survival of patients with advanced epithelial ovarian cancer.