生存时间5年以上晚期卵巢上皮性癌的预后因素分析

Retrospective analysis of patients with advanced epithelial ovarian cancer whose survival beyond five years

目的了解生存时间5年以上的晚期卵巢上皮性癌的临床病理特征,并为晚期卵巢癌的临床治疗提供帮助。方法回顾性分析1994年1月至2004年12月北京大学第一医院收治的141例晚期卵巢癌患者的临床资料,按生存时间分为两组,生存期5年以上的46例为生存期≥5年组,生存期小于5年的95例为生存期<5年组,比较两组的临床资料,并分析影响预后的因素。结果两组患者术后残余病灶大小比较,生存期≥5年组术后残余病灶≤2cm者占80.4%,明显高于生存期<5年组的45.3%(P<0.001);两组采用TP化疗方案者比较,差异无统计学意义(P>0.05),生存期≥5年组化疗至少6个疗程占89.1%,明显高于生存期<5年组的77.9%(P<0.05)。单因素分析显示,Ⅲa、Ⅲb期卵巢癌较Ⅲc和Ⅳ期预后好;残余病灶≤2cm者较残余病灶>2cm者预后好;TP方案或加用其他二线药物化疗者较CAP或CP方案化疗者预后好;术后联合化疗≥6个疗程者较<6个疗程者预后好。COX逐步回归分析显示,仅残余病灶大小及化疗疗程数对预后有影响。结论对晚期卵巢上皮性癌患者应积极施行满意的肿瘤细胞减灭术,并给予紫杉醇+卡铂方案6个以上疗程的化疗,以提高患者的5年生存率。

Objective To evaluate the clinicopathological features of advanced epithelial ovarian cancer in recent 10 years and to analyze the factors associated with prognosis improvement.Methods One hundred and forty-one patients with advanced epithelial ovarian cancer treated in our hospital from January 1994 to December 2004 were analyzed retrospectively.They were divided into two groups based on their overall survival time.Forty-six patients whose overall survival time was beyond five years were included in the first group and the other ninety-five patients were in the second group.The clinicopathological features were compared and factors associated with survival were identified.Results The residual tumor size was remarkably different.Those with residual tumor size ≤2 cm was 80.4% in the first group,which was 45.3% in the second group.There was differences in chemotherapy cycle between the two groups：89.1% patients in the first group were given 6 or more cycles of chemotherapy,the number was 77.9% in the second group.Univariate analysis revealed that patients with stage Ⅲa and Ⅲb,residual tumor size ≤2 cm,6 or more cycles of chemotherapy were associated with better prognosis.Cox regression analysis identified only residual tumor size and chemotherapeutic cycles were independent prognostic factors.Conclusions The optimal cytoreductive surgery and 6 or more cycles of TP chemotherapy are necessary to improve the survival of patients with advanced epithelial ovarian cancer.