Ⅲ期上皮性卵巢癌的治疗与预后

Treatment and prognostic factors of stage III epithelial ovarian cancer

目的 探讨影响Ⅲ期上皮性卵巢癌预后的临床病理因素以及手术和化疗对预后的作用。方法对1970年1月～1992年12月我院收拾的Ⅲ期上皮性卵巢癌67例进行回顾性分析。所有患者经初次手术后病理检查诊断并按FIGO标准分期,20例行二次手术,4例行三次手术。63例于术后接受化疗,化疗方案为FCT、FAC、CAP、马法兰等,分别为2-12个疗程不等。结果 Ⅲ期上皮性卵巢癌的2年及5年生存率分别是43.12％和24.17%。分组比较,5年生存率Ⅲa期100%、Ⅲb期14.05%和Ⅲc期23.64%( P<0.005);5年生存率透明细胞癌0.005％,粘液性囊腺癌1.76%,浆液性囊腺癌28.70%和内膜样癌36.27％(P<0.005);G1的5年生存率为87.50% 、G2为48.21%和G3为1.13%(P<0.005);术后残留癌小于2 cm的5年生存率69.50%,大于2 cm的为7.54％(P<0.005);化疗小于8个疗程的5年生存率12.49% ,大于8个疗程的47.55%(P=0.046)。结论Ⅲ期上皮性卵巢癌的预后与临床亚分期、病理类型、组织分级、术后残留癌大小及化疗疗程数相关,与年龄无关。专人、定期、全面的随访监测对提高生存率有重要意义。

Objective To study the relationship between clinical pathological factors and prognosis of stage Ⅲ epithelial ovarian cancer, also to notice the role of operation and chemotherapy on the prognosis. Methods 67 cases with stage Ⅲ epithelial ovarian cancer admitted in our hospital from Jan. 1970 to Dec. 1992 were studied retrospectively. All of them underwent primary operations, with postoperative pathological diagnosis and staging according to FIGO. 20 cases had the second operations and 4 had the third. 63 cases had postoperative chemotherapy, 2-12 courses of FAT, FAC, CAP or melphalan. Results 2 -year and 5 - year survival rates were 43.12% and 24.17% respectively. Stage III a had a better 5 - year survival rate than Ⅲ b and IIIc (P<0.005). Clear cell carcinoma and mucinous adenocarcinoma were with poorer prognosis than serous and endometri-oid adenocarcinoma ( P < 0.005). Grade 1 showed better survival rate than Grade 2 and Grade 3 (P < 0.005). Patients with residua] disease after primary operadons smaller than 2cm had a better prognosis than those larger than 2cm ( P < 0.005). Patients accepting chemotherapy more than 8 courses showed higher 5 - year survival rate than those less than 8 courses ( P < 0.05). Conclusions The prognosis of stage III epithelial ovarian cancer is related to FIGO substage, pathology, histologic grade. Optimal cytoreducdve surgery with proper chemotherapy and also the close follow - up play important role for increasing the survival rate.