晚期卵巢癌预后相关因素分析

Analysis of prognostic factors in advanced ovarian cancer.

目的:探讨血糖、临床病理特征与晚期卵巢癌预后的关系。方法:回顾分析天津市中心妇产科医院2003年1月～2008年12月收治并随访到的159例Ⅲ、Ⅳ期上皮性卵巢癌患者的临床资料。采用Kaplan-Meier法分析生存时间,单因素分析各变量与预后的关系用log-rank检验,多因素分析用Cox风险比例回归模型。结果:25例血糖≥6.10mmol/L患者3年(47.96%)及5年(32.57%)生存率低于血糖<6.10mmol/L者(P<0.05)。Ⅲc期卵巢癌患者的3、5年生存率分别为54.36%和34.51%,Ⅳ期患者的3、5年生存率分别为32.49%和15.92%(P<0.05)。组织学分化为G2和G3者3、5年生存率分别为45.89%和31.79%,低于G1者(P<0.05)。残余肿瘤直径>2cm患者3、5年生存率分别为39.12%和26.76%,低于残余肿瘤直径≤2cm者(P<0.05)。浆液性、黏液性、子宫内膜样、未分类4组病理类型患者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,血糖高低[相对危险度(RR)为2.008,95%置信区间(CI)为1.179～4.018,P=0.034]、手术病理分期(RR=2.391,95%CI为1.345～4.198,P=0.024),组织学分化(RR=2.363,95%CI为1.351～4.193,P=0.032)及残余肿瘤大小(RR=3.564,95%CI为2.683～6.857,P=0.01)是卵巢癌的预后因素。结论:血糖、手术病理分期、组织学分化、残余肿瘤直径可以作为卵巢癌的预后因素。

Objective：To analyze the relationship between blood glucose and clinico-pathological features and the prognosis of patients with advanced epithelial ovarian cancer.Methods：A retrospective analysis was conducted on 159 patients with stage Ⅲ,Ⅳ ovarian cancer from January 2003 to December 2008.Chi-square test,survival analysis,univariate and COX proportional hazard analysis were used to identify prognostic factors for patients with advanced epithelial ovarian cancer.Results：The 3-year overal survial（OS） and 5-year OS in 25 patients with blood glucose ≥6.10mmol/L were 47.96% and 32.57% respectively,which were lower than that of patients with blood glucose 6.10mmol/L.The 3-year OS and 5-year OS in patients with G2/G3 tumor were 45.89% and 31.78% respectively,which were significantly lower than that of patients with G1 tumor.No significant differences were observed in OS between pathological subtypes,including serous,mucinous,endometrioid and others,respectively（P0.05）.Multivariate COX proportional hazard model analysis indicated that blood glucose,stage,tumor grade,and residual tumor size were independently associated with the survival rate in patients with advanced epithelial ovarian cancer.Conclusions：Blood glucose,stage,tumor grade and residual tumor size were prognostic factors of patients with andvanced epithelial ovarian cancer.