卵巢恶性肿瘤患者手术后激素治疗对其预后影响的初步探讨

Relationship between hormone therapy in women with ovarian malignancy and prognosis

目的探讨卵巢恶性肿瘤患者手术后激素治疗（HT）对其预后及相关因素的影响。方法对31例卵巢恶性肿瘤患者（HT组）手术后使用结合雌激素或尼尔雌醇加甲羟孕酮作为HT，同时选择同期收治的年龄、临床期别和病理类型大致相同的44例卵巢恶性肿瘤患者（非HT组）作为对照。采用免疫组化方法对上述患者癌组织中的雌激素受体（ER）α、ERβ及孕激素受体（PR）表达进行测定；采用放射免疫或酶联免疫吸附试验方法对上述患者血清转化生长因子仪（TGFα）和降钙素水平进行测定。同时采用欧洲癌症研究与治疗组织的生命质量核心量表和自制的特异性量表对上述患者和健康绝经对照妇女进行问卷调查。结果（1）HT组和非HT组患者的平均生存时间分别为（1108±52）、（1086±43）d，两组比较，差异无统计学意义（P=0．940）。经Cox比例风险模型分析，HT不是影响预后的独立因素。（2）HT组和非HT组癌组织中ERoL、ER13及PR不同表达状况患者的累积生存期比较，差异均无统计学意义（P〉0．05）。（3）手术前、手术后20d、手术后半年至1年，HT组患者的血清TGFα水平分别为（30±23）、（13±7）、（13±10）ng／L，与非HT组分别比较，差异均无统计学意义（P〉0．05）。（4）非HT组患者在手术后半年至1年的血清降钙素水平明显高于HT组患者[分别为（141±13）、（90±18）μg／L]，两组比较，差异有统计学意义（P〈0．05）；而HT组患者与其手术前[（93±14）μg/L]比较，差异无统计学意义（P〉0．05）。（5）生命质量核心量表功能子量表的躯体功能、情绪功能得分及症状子量表得分，HT组分别为（1．84±1．50）、（1．45±0．82）、（6．82±2．61）分，非HT组分别为（12．69±10．20）、（12．90±11．61）、（21．82±10．85）分，两组分别比较，差异均有统计学意义（P〈0．05）。在特异性量表中，HT组和非HT组患者的性生活、植物神经功能失调得分，HT组分别为（1．05±0．74）、（1.77±1．08）分，非HT组分别为（10．104-3．21）、（13．09±4．30）分，两组分别比较，差异均有统计学意义（P〈0．05）。结论HT对卵巢恶性肿瘤的预后无明显不良影响。HT有助于保持血清降钙素水平的稳定并改善其生活质量，血清TGFα水平以及癌组织中ERα、ERβ及PR的表达状况对HT与预后的关系无影响。

Objective To explore the relationship between hormone therapy （HT） in women with ovarian malignancy and prognosis. Methods HT was used in 31 patients with ovarian cancer after surgery, and 44 cases with ovarian cancer served as control. The expression of estrogen receptor （ER） α, ERβ and progesterone receptor （PR） was detected by immunohistochemical staining respectively. The level of serum calcitonin and transforming growth factor α （TGFα） was detected by radio-immune and enzyme-linked immunosorbent assay pre-or post-surgery, as well as half a year to one year later post-surgery respectively in these cases. The survival curve of Kaplan-Meier and log-rank test as well as scale risk of Cox model were used to analyze the relationship between HT and prognosis of ovarian cancer. Results （ 1 ） The results of log-rank test showed that there was no difference in survival curve of patients with or without HT [ （ 1108 ± 52）, （ 1086 ± 43 ） d ; P = 0.940 ] ; the results of scale risk of Cox model also showed that HT was not an independent prognosis factor for patients with HT. （2） There was no relationship with HT and the accumulated survival in patients with either positive or negative expression of ERα, ERβ and PR in tissue; as well as between HT and the level of serum TGFa pre-, post-surgery, or half a year to one year after surgery. （3） The level of serum calcitonin in patients without HT post-surgery half a year to one year later was higher than that pre-surgery [ （141 ± 13）, （95 ± 11） μg/L; P 〈0. 05], but there was no significant difference between patients with HT half a year to one year later post-surgery and pre-surgery [（90 ± 18 ）μg/L, （93±14）μg/L; P 〉 0.05 ]. （4） There was a significant difference in body and emotion function between HT and without HT groups [（1.84 ±1.50）, （1.45 ±0.82）; （12.69±10.20）, （12.90 ± 11.61 ）; P 〈 0. 05 ], as well as in sex quality and autonomic nerve maladjustment and in the special list made [（1.05±0.74）, （1.77 ±1.08）; （10.10±3.21）, （13.09 ±4.30）; P〈0.05]. Conclusions There is no adverse influence on prognosis in using of HT for patients with ovarian cancer after surgery. HT for patients with ovarian cancer post-surgery can help keep a stable level of serum calcitonin as well as improve the quality of life.