卵巢上皮性癌序贯化疗41例临床分析

The analysis of the sequential chemotherapy in 41 patients with epithelial ovarian carcinoma

目的探讨卵巢上皮性癌不同化疗方案的序贯化疗效果。方法回顾性分析1998年1月～2007年11月肿瘤细胞减灭术后规范化疗的卵巢上皮性癌患者41例,其中序贯化疗组11例,应用化疗方案为TP和/或CAP和/或IAP;常规化疗组30例,应用化疗方案为TP或CAP,比较化疗毒性反应、反应率、无疾病进展期和总生存时间。结果①两组在年龄、病理类型、临床分期、组织分化程度和术后残留病灶方面差异无统计学意义(P>0.05);②序贯化疗组的完全缓解率(CR)、部分缓解率(PR)和总缓解率(CR+PR)分别为57.1%、23.8%和81.0%,常规化疗组的CR、PR和CR+PR分别为55.3%、23.4%和78.7%,组间比较,差异无统计学意义(P>0.05);③序贯化疗组中位无疾病进展和中位总生存时间分别为41个月和60个月,常规化疗组分别为30个月和59个月,较常规化疗组延长,但差异无统计学意义(P>0.05);④序贯化疗组发生3～4级白细胞减少症4例,占36.36%,常规化疗组发生10例,占33.33%,组间比较,差异无统计学意义(P>0.05);非血液系统化疗毒性反应主要为神经系统毒性反应,序贯化疗组发生3～4级神经系统毒性反应1例(9.09%),常规化疗组6例(20%)。结论序贯化疗可延长卵巢癌患者的无疾病生存期,且毒性反应减少,有待今后进一步研究后用于卵巢癌一线化疗。

Objective To evaluate the effective of the sequential chemotherapy in epithelial ovarian cancer. Method 41 patients with epithelial ovarian carcinoma who underwent cytoreduction and received combined chemotherapy in Peking university People＇s Hospital from Jan, 1999 to Nov, 2007 were enrolled. Of these, 30 patients were included in routine combined chemotherapy group and given TP or CAP. 11 patients were included in sequential chemotherapy group and given TP and/or CAP and/or IAP. The toxicity, response rate （RR）, progression - free survival （PFS） and overall survival （OS） in both groups were evaluated. Results （1） There were no significant differences in the age, pathologic types, stages, grades and residual disease between both groups （P〉0. 05）. （2） 57.12%, 23.8 % and 81% patients achieved complete response （CR）, partial response （PR） and overall response rate （CR＋PR） in sequential chemotherapy group. And 55.3%, 23. 4% and 78. 7% patients had CR, PR and CR＋ PR in control group. There was no significant difference betwen both groups （P〉0. 05）.（3） There were no significant differences in PFS and OS between both groups （P〉0. 05）. However, the median PFS and median OS in sequential chemotherapy patients were longer than those of control group. （4） The most common toxicities were neutropenia in hematologic. Grade 3-4 neutropenia occurred in 4 （36.36 %） patients with sequential chemotherapy and 10 （33.33%） patients with routine combined chemotherapy. There was no significant difference in them. Peripheral neuropathy was the major toxicity in nonhermtologic and observed in 1 （9. 09%） and 6 （20. 00%） patients with grade 3-4 one respectively. Conclusion The sequential chemotherapy may lead to improved survival with less toxicity and be a feasible strategy in epithelial ovarian cancer.