中晚期卵巢上皮癌长期存活及预后分析

Long term survival and prognostic factors of advanced epithelia ovarian carcinoma

目的：评价中晚期卵巢上皮癌的长期生存结果，评估预后因素对于中晚期卵巢上皮癌总的生存影响。方法：回顾分析1990年1月-1995年1月在我院初诊的中晚期卵巢上皮癌患者的临床资料。采用COX模型分析并进行检验，发现及评价预后生存指标。结果：在单变量分析中得出，年龄、FIG0分期、病理组织学类型、残余瘤的大小和化疗疗程的多少是预后生存指标。在多变量COX风险比例模型中得出，FIGO分期、病理组织学类型、残余瘤的大小和化疗疗程的多少是预后生存指标。以FIGOⅣ期的死亡风险作标准，FIGOⅡ期的死亡风险为0．088，P〈0．001；FIGOⅢA期的死亡风险为0．128，P〈0．001；FIGOⅢB期的死亡风险为0．290，P〈0．001；FIGOⅢC期的死亡风险为0．594，P=0．029。以残余瘤直径〉2cm组死亡风险作标准，残余瘤直径≤2cm组的死亡风险为0．391，P〈0．001。以浆液性癌为标准，则非浆液性癌的死亡风险为0．638，P=0．010。以化疗疗程≥6个疗程组的死亡风险为1作标准，则化疗疗程〈6个疗程组的死亡风险为4．466，P〈0．001。结论：本研究发现，肿瘤细胞减灭术残余灶的大小和化疗的疗程数与预后关系密切，其中化疗的疗程数对生存期的影响更大。

OBJECTIVE： To evaluate long-term results and to assess prognostic factors which have an impact on overall survival in patients with advanced epithelial ovarian carcinoma. METHODS.. From Jan 1990 to Jan 1995, 208 patients with advanced epithelial ovarian carcinoma admitted to our hospital for primary treatment were eligible for retrospective analysis. Statistical methods included Kaplan-Meier survival curves, logrank test and multivariate analysis were used. RESULTS： Age, FIGO stage, histologic type, residuum of surgery, and the number of courses of chemotherapy were significant prognostic indicators in univariate analysis. In multivariate analysis, the risk of mortality according to FIGO stage was 0. 088, P〈0. 001 for FIGO Ⅱ;0. 128,P〈0. 001 for FIGO ⅢA; 0. 290, P〈0. 001 for FIGO ⅢB;0. 594, P=0. 029 for FIGO ⅢC. In comparison with FIGO Ⅳ, patients with a serous epithlial carcinoma had a 1.6-fold higher risk of mortality than patients with other histologic types, RR = 0. 638, P = 0. 010. Patients with residual tumor 〉2 cm had a 2.6-fold higher risk of mortality than patients with residual tumor ≤2 cm, P〈0. 001. Patients with 〈 6 courses of chemotherapy had a 4. 466-fold higher risk of mortality than patients with ≥6 courses of chemotherapy, RR= 4. 466,95%, P〈0. 001. CONCLUSION：The prognosis of advanced epithelial ovarian carcinoma following cytoreductive surgery is influenced by residual tumor, and the number of courses, of chemotherapy.