通过临床因素预测卵巢上皮癌化疗的耐药

Prediction of chemoresistance in epithelial ovarian cancer by clinical factors

目的比较化疗敏感性不同的卵巢上皮癌的临床特征及预后差异，明确影响化疗耐药的临床因素。方法参照2010版{NCCN指南》，根据初治后无瘤间期（DFI）将244例上皮性卵巢癌分为铂耐药、铂部分敏感、铂敏感3组，3组患者的发病年龄、病理类型构成、原发病灶大小、腹腔化疗及初始静脉化疗具体方案（泰素＋卡铂或环磷酰胺＋阿霉素＋顺铂）差异无统计学意义。比较3组患者的一般情况、临床特征、治疗方案及预后生存差异。结果244例卵巢上皮癌，铂耐药、铂部分敏感、铂敏感的比率分别为23．4％、13．5％、63．1％。晚期、未达满意肿瘤细胞减灭术的患者铂耐药概率增高（P〈0．01）。铂部分敏感组低分化比率高于铂敏感组（P〈0．05）。铂耐药组的CA125及淋巴转移率高于铂敏感组（P〈0．05，P〈0．01）。3组患者的5年生存率分别为：9．5％、38．4％、81．9％，任意两组的总生存（OS）及无疾病进展生存（PFS）差异均有统计学意义（均P〈0．01）。结论肿瘤晚期、中低分化、CA协升高（超过1000×10^3U／L）、盆腔、腹主动脉旁淋巴结阳性、未达到满意的肿瘤细胞减灭，则耐药或部分敏感的概率高，预后差。临床因素对耐药性预测有参考价值，但不能准确定性。

Objective To compare the clinical features and prognosis among patients with different chemosensitivity and determine the specific clinical influencing factors of chemotherapeutic resistance. Methods In references to the 2010 NCCN clinical practice guidelines on ovarian cancer and in accordance with the length of disease-free interval, 244 patients were divided into 3 groups ： platinum-resistant, partially sensitive and platinum-sensitive. The differences of clinical features, treatment and prognosis were compared among these 3 groups. Results The resistant, partially sensitive, sensitive rates to platinum-based chemotherapy were 23.4%, 13.5% and 63.1% respectively. Such factors as age, pathological type, primary tumor size. intraperitoneal chemotherapy and venous chemotherapy regimen had no effect on the responses to the combination platinum-based chemotherapy. The platinum-resistant percentage of advanced stage patients without optimal cytoreductive surgery was higher（P 〈 0. O1 ）. The poorly differentiated rate of partially sensitive patients was higher than that of platinum-sensitive ones （P 〈 0. 05）. The CA125 level and lymph node metastasis rate of platinum-resistant patients were higher than those of platinum-sensitive patients （P 〈 0. 05, P 〈 0. 01 ）. The 5-year survival rates of resistant, partially sensitive and sensitive patients were 9.5%, 38.4% and 81.9% respectively. There were statistics differences in overall survival and progression-free survival among the 3 groups （P 〈 0. 01 ）. Conclusion Advanced ovarian cancer, poor differentiation, lymph node-positivity, CA125 rising above 1000 ×10^3 U/L and suboptimal cytoreductive surgery would lead to the occurrences of resistance or partially sensitivity. Clinical factors have some reference values for the prediction of resistance. But it is impossible to accurately determine chemoresistance.