新辅助化疗158例晚期卵巢癌治疗应用

Application of Neoadjuvant Chemotheraphy in 158 Cases with Ovarian Cancer

[目的]探讨术前新辅助化疗在晚期卵巢癌治疗中的应用价值。[方法]1987～1998年初次治疗的Ⅲ期、Ⅳ期卵巢癌患者303例,Ⅲ期251例,Ⅳ期52例。145例直接手术减瘤(直接手术组),其中Ⅲ期136例,Ⅳ期9例;158例术前行新辅助化疗(新辅助化疗组),其中Ⅲ期115例,Ⅳ期43例。[结果]无残存肿瘤、残存肿瘤≤2cm、2.1～5cm、>5cm中位生存时间,Ⅲ期分别为54、33、24、16个月,Ⅳ期为42、30、17、16个月(P<0.05)。5年生存率:Ⅲa期、Ⅲb期为36.7%,Ⅲc期20.8%,Ⅳ期为22.4%。有、无新辅助化疗总的中位生存时间21.3个月比27.0个月,两组之间无统计学差异(P=0.062)。术后化疗疗程数<6个疗程与≥6个疗程相比中位生存时间17个月与39个月(P<0.001)。术前新辅助化疗疗程数对生存率无影响,增加疗程数并不能提高生存率。[结论]术前新辅助化疗手术满意减瘤率高,总的生存期与常规手术组无差异。

[Purpose ] To explore the application value of pre-operative neoadjuvant chemotherapy （NAC） in advanced ovarian cancer. [Methods] Three hundred and three patients with stage Ⅲ （251 cases） and （52 cases） ovarian cancer underwent primary therapy during 1987-1998. One hundred and forty-five patients （Ⅲ, 136 cases and Ⅳ, 9 cases） were treated with primary debulking surgery （PDF）（PDF group）. The other 158 patients （Ⅲ, 115 cases and Ⅳ, 43 cases） accepted NAC before operation（NAC group）. [Results] There was no difference in age between two groups. But patients with stage m c and IV in NAC group were more than that in PDF group. The residual tumor 〉2cm in PDF group was more than that in NAC group with stage m. And in stage IV, patients with residual tumor ≤ 2cm in NAC group was more than that in PDF group （P〈0.05）. The median survival time for patients with no residual tumor, residual tumor ≤2cm, 2.1-5cm, 〉5cm were 54, 33, 24, 16 months in stage Ⅲ, and 42, 30, 17, 16 months in stage Ⅳ, respectively（P〈 0.05）. The 5-year survival for stage mA/mB, ⅢC and IV was 36.7%, 20.8% and 22.4% respectively. No significant difference was found in the median survival time between the PDF and NAC groups （21.3 months vs. 27.0 months, P=0.062）. The median survival time was 39 months in patients treated with 1〉 6 cycles of postoperative chemotherapy, and 17 months in 〈 6 cycles （P〈 0.001）. The number of NAC cycles had no influence on patients＇ survival. That means more NAC cycles couldn＇t improve patients＇ outcome. [Conclusion] The NAC patients have more optimal cytoreduction with no significant difference in overall survival compared to no NAC operation.