卵巢癌术后化疗联合醋酸甲羟孕酮抑制盆腔病理血管生成的研究

Inhibitory Effects of Medroxyprogesterone Acetate Conjugated with Postoperative Chemotherapy for Ovarian Epithelial Cancer on Pathological Angiogenesis

目的探讨卵巢癌术后化疗联合醋酸甲羟孕酮(MPA)抑制盆腔病理血管生成作用及其对预后的评价。方法实验组53例,Ⅰ/Ⅱ期30例(56.6%),Ⅲ/Ⅳ期23例(43.4%)。化疗方案:2001年以前采用PAC(顺铂+表阿霉素+环磷酰胺)或PC(顺铂+环磷酰胺);2001年及以后为PT方案(紫杉醇+卡铂)静脉化疗6个疗程;第7个疗程行髂内动脉化疗栓塞,同时数字减影观察盆腔病理血管。术后1年时,再增加1次髂内动脉化疗栓塞造影。术后进食开始服用MPA250mg/d×12个月。每次化疗前测定CA125。对照组37例,Ⅰ/Ⅱ期20例(54.1%),Ⅲ/Ⅳ期17例(45.9%),除不用MPA外,卵巢癌手术后化疗方案及检查方法与实验组相同。随访两组3年、5年生存率。结果①CA125水平实验组在第7疗程结束后和术后1年时,Ⅰ/Ⅱ期和Ⅲ/Ⅳ期与对照组比较下降明显,差异有显著性(P<0.05,P<0.05;P<0.05,P<0.01)。②实验组髂内动脉分支血管走形迂曲、紊乱及火焰状病理血管者明显少于对照组,差异有显著性(P<0.05);第7疗程后盆腔病理血管改变与血CA125水平呈明显正相关(r=0.95,P<0.001),即盆腔造影有病理血管者,血CA125升高。③Ⅰ/Ⅱ期3年和5年生存率实验组分别为88.33%、41.23%。对照组分别为79.59%、34.31%,两组比较实验组高于对照组,差异有显著性(P<0.01,P<0.05);Ⅲ/Ⅳ期3年和5年生存率实验组分别为17.52%,1.34%。对照组分别为12.49%、0,两组比较实验组高于对照组,差异有显著性(P<0.05,P<0.01)。结论MPA对卵巢癌盆腔病理血管生成有明显抑制作用;MPA联合化疗可延长卵巢癌患者的生存时间;髂内动脉造影显示盆腔病理血管,可作为评价治疗效果及预后的指标;连续服用12个月MPA是安全的。

Objective To investigate the effects of medroxyprogesterone acetate （MPA） combined with chemotherapy against pathological angiogenesis after surgery for ovarian epithelial cancer, and to evaluate their effects on the prognosis.Methods Fifty-three patients, 30 in phase Ⅰ/Ⅱ （56.6%） and 23 in phase Ⅲ/Ⅳ （43.4%）, were admitted to the experimental group. PAC or PC chemotherapy regime was taken before 2001, and PT chemotherapy regime since 2001. Intravenous chemotherapy of six circles was conducted. Then the internal iliac artery chemoembolization was performed in the 7th circle of chemotherapy and pelvic angiography by DSA followed, which were repeated again one year later. MAP （250 mg/d） was orally administered for 12 months after operation. Another 37 patients, 20 in phase Ⅰ/Ⅱ （54.1%） and 17 in phase Ⅲ/Ⅳ （45.9%）, were admitted to the control group. They received the same treatment as the experimental group except MPA. The level of CA125 was monitored before each circle of chemotherapy. The 3-year and 5-year survival rates were followed up. Results At the end of the course of chemotherapy and one year after operation, CA125 level of Ⅰ/Ⅱ and Ⅲ/Ⅳ patients in the experimental group declined significantly compared with that in the control group （P〈0.05, P〈0.05; P〈0.05,P〈0.01, respectively）. The tortuous branches of internal iliac artery and pathological flame-shaped vessels in the experimental group were fewer than those in the control group （P〈0.05）. The pathological changes of pelvic vessels were positively correlated to the CA125 level （r=0.95, P〈0.001）, suggesting the occurrence of pathological pelvic vessels was accompanied with increased CA125. The 3-year and 5-year survival rates of Ⅰ/Ⅱ and Ⅲ/Ⅳ patients （88.33% and 41.23%, 17.52% and 1.34%） in the experimental group were significantly higher than those in the control group （79.59% and 34.31%, 12.49% and 0） （P〈0.01, P〈0.05; P〈0.05, P〈0.01）.Conclusion MPA can inhibit the angiogenesis after the surgery for ovarian cancer. MPA combined with chemotherapy can improve the survival rate of patients with ovarian epithelial cancer. Pathologic pelvic vessels observed in internal iliac artery angiography, can be taken as one factor to evaluate the therapeutic effects and prognosis. MPA is safe for oral taking consistently for 12 months.