晚期卵巢癌术前新辅助化疗的临床研究

Clinical Research on Preoperative Neoadjuvant Chemotherapy for Advanced Ovarian Cancer

目的探讨新辅助化疗对晚期卵巢癌的临床意义。方法①对56例Ⅲc、Ⅳ期上皮性卵巢癌采用新辅助化疗,肿瘤细胞减灭术加以铂类和(或)紫杉醇为主的化疗组(A组):术前给予1～3个疗程以铂类和(或)紫杉醇为主的化疗,途径为静脉+腹腔或静脉化疗,每3周1次,56例患者共施行新辅助化疗109次;②49例Ⅲc、Ⅳ期上皮性卵巢癌传统肿瘤细胞减灭术加以铂类和(或)紫杉醇为主的化疗组(B组);A,B两组均按卵巢癌手术原则行最大限度减瘤术,部分患者进行腹膜后淋巴清扫,术后1周左右开始化疗,均采用联合化疗6～8个疗程,方案和剂量同新辅助化疗。结果A组新辅助化疗总有效率(CR+PR)为85.7%,胸、腹水控制有效率为93.6%。A组满意肿瘤细胞减灭术(术后残瘤最大直径<2cm)80.4%,减瘤术(术后残瘤最大直径≥2cm)19.6%;B组满意肿瘤细胞减灭术51.0%,减瘤术49.0%,两组比较有显著性差异(P<0.01),A组缩短了手术时间,减少手术出血,为术后化疗创造了有利条件,新辅助化疗毒副反应轻,可以耐受。5年生存率A组为35.7%,B组为15.6%,两组比较有显著性差异(P<0.05)。结论新辅助化疗有可能为晚期上皮性卵巢癌患者创造手术条件,提高达到满意肿瘤细胞减灭术,改善生存质量,提高生存率。

Objective To study the clinical significance of neoadjuvant chemotherapy for advanced ovarian cancer （OC）. Methods 56 patients with stage Ⅲ and Ⅳ ovarian cancer received neoadjuvant chemotherapy,cytoreductive surgery, and chemotherapy with platinum and （or） paclitaxel（ group A）, Chemotherapy was given before the cytoreductive surgery. 1 to 3 cycles of chemotherapy was given once three weeks. A total of 109 courses of neoadjuvant chemotherapy were given to 56 patients. 49 patients with Ⅲ c, Ⅳ epithelium OC （group B） received traditional cytoreductive surgery and adjuvant chemotherapy with platinum and （or） paclitaxel. Patients in both groups received cytoreductive surgery according to the principle of OC operation, and some patients also received retroperitoneal lymph node dessection. Adjuvant chemotherapy was given about 1 week after the surgery. 6-8 courses of adjuvant chemotherapy were given with the same protocol and dosage as neoadjuvant chemotherapy. Results The total response rate （CR ＋ PR） of neoadjuvant chemotherapy in group A was 85.7% ,and the effective rate of controlling pleural fluid and ascites was 93.6%. 80.4% of patients in group A and 51.0% in group B got satisfactory cytoreductive surgery （ maximum diameter of tumor after operation 〈 2 cm）. 19.6% of patients in group A and 49.0% in group B got common cytoreductive surgery （ maximum diameter of tumor after operation ≥ 2 cm）. Both differences were statistically significant. The operation duration of group A was shortened and also the operation bleeding reduced,which created advantageous condition for chemotherapy. The toxicities of neoadjuvant chemotherapy was mild and tolerable. The 5 years survival rate of patients in group A and B was 35.7% and 15.6% respectively. The difference was statistically significant（ P 〈 0.05 ）. Conclusion Neoadjuvant chemotherapy was useful in advanced epithelium OC patients. Surgical operation could be more easily performed after neoadjuvant chemotherapy. Neoadjuvant chemotherapy could also improve the survival rate and quality of life of patients with OC.