晚期上皮性卵巢癌预后的相关因素分析

Analysis of prognostic factors in advanced epithelial ovarian cancer

目的探讨影响晚期卵巢癌预后的相关因素。方法对Ⅲ～Ⅳ期原发性上皮性卵巢癌患者共119例的临床病理资料进行回顾性分析,采用Kaplan-Meier法进行生存时间分析,用Cox风险比例回归模型对影响预后的因素进行多因素分析。结果91例Ⅲc期卵巢癌患者的3、5年生存率分别为55.42%和35.62%,Ⅳ期(6例)的3年生存率仅为30.14%。88例残余肿瘤直径≤2cm患者3、5年生存率分别为58.31%和38.83%,高于残余肿瘤直径>2cm者(P<0.05)。组织学分化为G2和G3者,3年(46.82%)及5年(31.53%)生存率明显低于G1者(P<0.05)。比较术前CA125<500U/ml,500～5000U/ml,以及>5000U/ml3组患者的生存情况,发现各组的远期生存率差异无统计学意义(P>0.05)。Cox风险比例回归模型进行多因素分析,发现手术病理分期[相对危险度(RR)=2.473,P=0.025],组织学分化[RR=2.316,P=0.033]及残余肿瘤的直径[RR=3.584,P=0.001]是独立预后因素。结论手术病理分期、组织学分化、残留肿瘤的直径是晚期卵巢癌独立的预后因素。

Objective To investigate the relationship between survival and the various prognostic factors in patients with advanced epithelial ovarian cancer. Methods A retrospective analysis was conducted on 119 patients with stage Ⅲ - IV ovarian cancer at our Department between January 1997 and December 2002. Outcomes of patients were studied by the method of Kaplan-Meier and compared by means of the log-rank test. Multivariate cox regression models were used to assess the correlatious between survival and the various prognostic factors. Results Ninety-one patients with stage Ⅲ c disease had 3-year o- verall survival （OS） and 5-year OS of 55.42% and 35.62% respectively, whereas the stage Ⅳ patients only had 30.14% 3- year OS. Eighty-eight patients with residual tumor size≤2cm had significantly better outcomes （58.31% in 3-year OS and 38. 83% in 5-year OS） compared with those having residual tumor size 〉 2cm （ P 〈 0.05 ）. The patients with tumor grade of G2 and G3 had 46.82% of 3-year OS and 31.53% of 5-year OS respectively,which were worse than the outcomes in the patients with G1 （P 〈0.05 ）. No significant difference was observed in OS in various levels of preoperative CAI25 subgroups, including CA125 〈 500U/ml,500 - 5 000U/ml and 〈 5 000U/ml, respectively （ P 〉 0.05 ）. Multivariate analysis confirmed the stage （ RR =2.473,P =0.025） ,tumor grade（RR -2.316,P =0.033） ,and residual tumor size 〉2cm（RR =3. 584,P =0.001 ） as the negative independent predictors for survival. Conclusion In our study, the stage, tumor grade, and residual tumor size were independence predictors of survival for advanced ovarian cancer.