复发性卵巢上皮癌二次减灭术意义及疗效影响因素

Significance of secondary cytoreductive surgery and influential factors in the treatment of patients with recurrent epithelial ovarian carcinoma

目的:探讨复发性卵巢上皮癌二次肿瘤细胞减灭术的意义及影响因素。方法:对85例复发性卵巢上皮癌进行回顾性临床病理资料及随访资料分析。结果:85例复发性卵巢上皮癌中,以存活≥3年为界,①58例行二次肿瘤细胞减灭术:32例浆液性囊腺癌中21例存活≥3年,22例高分化癌中18例存活≥3年,37例首次残余瘤<2 cm中28例存活≥3年,24例两次手术间隔≥1年中19例存活≥3年,31例二次手术后残留2 cm中25例存活≥3年,33例二次术后新化疗中27例存活≥3年;②27例未行二次手术中,21例单纯采用新化疗者9例存活≥3年,6例采用中药或放弃治疗者2例存活≥3年。结论:单纯二次肿瘤细胞减灭术对患者预后无积极意义,配合有效化疗药物的二次肿瘤细胞减灭术对提高患者生存率有积极意义;二次肿瘤细胞减灭术相关的影响因素为术后是否行有效化疗、首次与二次术后残余瘤大小、病理分级及两次手术间隔,其中最重要的为前三者,但与病理类型无关。

Objective： To explore the significance and influential factors of sccondary tumor cell surgery （STRS） in the treatment of patients with recurrent epithelial ovarian carcinoma. Methods： Retrospective analyses were made on 85 cases of clinical pathologic data and clinical follow- up sheets in patients with recurrent epithelial ovarian carcinoma. Results： 3 - year survival rate was considered as standard in 85 patients. （1） 58 patients were administered STRS and such were the results. Of the 32 serous cystadenocarcinoma, 21 cases survived longer than 3 years; Of the 22 well- differentiated carcinoma case.s, 18 survived longer than 3 years; Of the 37 first surgery residual cases （with tumor size smaller than 2 cm）, 28 survived over 3 years; Of the 24 twice surgery cases （with an interval longer than 1 year）, 19 survived over 3 years; Of the 31 STRS cases （with tumor size .smaller than 2 cm）, 25 survived over 3 years; Of the 33 cases with new chemotherapy after STRS, 27 survived over 3 years. （2） 27 cases were not administered STRS. Of 21 cases with only new chemotherapy, 9 survived over 3 years; Of the 6 cases abandoning any therapy or adopting traditional Chinese medicine, 2 survived over 3 years. Conclusion： Single STRS is of no significance to the prognosis, while STRS coupled with effective chemotherapy is of positive importance to the increased survival rate of patients. Effective chemotherapy, residual tumor size after surgery, pathological grade and the interval between surgerie; are all important influential factors affecting STRS result, with the first 3 being the most influential factors, but all with no correlation with pathological type.