晚期卵巢癌术后顺铂与卡铂腹腔化疗的近期作用比较

Recent Efficacy and Toxicity of Cisplatin and Carboplatin in Intraperitoneal Chemotherapy for Advanced Ovarian Cancer

【目的】探讨顺铂(DDP)与卡铂(CBP)在卵巢癌腹腔化疗中的作用。【方法】对我院2004年1月至2008年9月136例卵巢癌病例进行回顾性分析,按入选标准入选37例,DDP组20例,CBP组17例。【结果】DDP组与CBP组术前及术后第1次化疗前的CA125水平比较,差异均无统计学意义(P>0.05)。第1次化疗后,DDP组比CBP组CA125能降到更低水平(P<0.05),但第2次、第3次或第4次化疗后两组的CA125水平比较,差异无统计学意义(P>0.05)。手术后有肉眼残余病灶的病例经第1次或第2次化疗后,DDP组比CBP组CA125均能降到更低水平(P<0.05)。手术后无肉眼残余病灶的,经第1次、第2次或第3次化疗后,DDP组与CBP组的CA125水平比较,差异无统计学意义(P>0.05)。两组在白细胞减少、消化道反应、肝功能损害、肾功能损害、脱发以及中止腹腔化疗等方面比较,差异均无统计学意义(P>0.05),但在腹痛方面,I级腹痛的发生率DDP组(40%,8/20)与CBP组(23%,4/17)比较,差异有统计学意义(P<0.05)。【结论】在经过理想的肿瘤细胞减灭术的晚期卵巢癌患者中,选用顺铂或卡铂行腹腔化疗都有效可行,但对仍有肉眼残余病灶的病例,选用顺铂能在较短的疗程内起效。

【Objective】 To evaluate recent efficacy and toxicity of cisplatin （DDP） and carboplatin （CBP） in the intraperitoneal chemotherapy for advanced ovarian cancer. 【Methods】 Retrospective analysis was utilized to analyze the clinical materials of 136 cases of ovarian cancer in the Third Affiliated Hospital of Sun Yat-sen University from January 2004 to September 2008, and 37 cases met the criteria, primary stage III, optimally cytoreduced ovarian cancer with full detection of CA125 prior to every cycle chemotherapy. All cases had high CA125 level before operation and at least 2 cycles of intraperitoneal chemotherapy. Because of the large range of CA125 levels, raw CA125 values were natural log transformed and compared using repeated measures analysis of variance （AVONA）. 【Result】 Twenty cases met inclusion criteria in the DDP group and 17 cases in the CBP group. There was no significant difference of CA125 between two groups before operation and first cycle chemotherapy （P〉0.05）. After the first cycle chemotherapy, CA125 levels in DDP group were lower than that in CBP group （P〈0.05）, but there were no significant difference between two groups after second,third or fourth cycle chemotherapy （P〉0.05）. For the patients with gross residual disease, CA125 levels in DDP group were lower than that in CBP group after first or second cycle （P〈0.05）, but for the patients without gross residual disease, there were no significant difference between two groups after first, second or third cycle chemotherapy （P〉0.05）. The rate of abdominal pain （I class） was higher in DDP group （40%,8 / 20） than that in CBP group （24% ,4 / 17）, but there were no significant differences between two groups in the toxicities of hypoleukemia, digestive disturbance, liver function damage, renal function damage, phalacrosis or discontinuation of intraperitoneal chemotherapy.【Conclusion】 Intraperitoneal chemotherapy with cisplatin or carboplatin was efficient and suitable for the advanced ovarian cancer after optimally cytoreductive surgery, but cisplatin lowered recent CA125 level sooner than carboplatin for those with small gross residual disease.