中间性肿瘤细胞减灭术对晚期卵巢癌治疗的价值

The evaluation of interval cytoreductive surgery in the management of advanced epithelial ovarian cancer

1 目的 探讨中间性肿瘤细胞减灭术在晚期卵巢癌治疗中的价值。方法 将曾行肿瘤细胞减灭术的晚期上皮性卵巢癌患者按照术前是否化疗分为两组,即初次肿瘤细胞减灭术组和中间性肿瘤细胞减灭术组,进行回顾性分析,比较两组患者与预后有关的指标及生存情况。结果1990年1月～1998年12月,收治ⅢC期、Ⅳ期上皮性卵巢癌患者,并施行了肿瘤细胞减灭术者共71例。其中行初次肿瘤细胞减灭术者45例,行中间性肿瘤细胞减灭术者26例。两组患者除中间性肿瘤细胞减灭术组在术前给予2～4疗程化疗外,手术范围基本相同。中间性肿瘤细胞减灭术组期别晚、分级高,预后不良的组织病理类型所占比例高,但治疗结果两组间达到满意肿瘤细胞减灭术的比例无明显差别。追踪随访初次肿瘤细胞减灭术组,5年生存率40.60％;中间性肿瘤细胞减灭术组,5年生存率对30.72%(P>0.8)。结论 对术前估计难以达到满意的肿瘤细胞减灭术晚期卵巢癌患者,行中间性肿瘤细胞减灭术有可能提高生存率。

Objective To evaluate interval cytoreductive surgery in the management of advanced epithelial ovarian cancer. Methods The patients who had cytoreductive surgery were divided into two groups according to whether they had received chemotherapy or not before operation. Retrospective analysis was made, while the prognostic factors and survival rates were compared. Results From Jan 1990 to Dec 1998, 71 cases of epithelial ovarian cancer in stage Ⅲ c and stage Ⅳ were admitted and all of them were treated by cytoreductive surgery in our hospital.Of which, 45 cases had primary cytoreductive surgeries, while the other 26 cases had interval cytoreductive surgeries with 2-4 courses of chemotherapies before the operations. Comparison of prognostic factors between the two groups showed that more patients with stage IV disease, higher cytological grade and poor aggressive histological type were in the group of interval cytoreductive surgery. However the rates of optimal cytoreductive surgery were similar. Five year survival rates of the two groups were 40.60% and 30.72 %, respectively (P>0.8) .Conclosions Patients who can not initially be cytoreduced to an optimal state should be considered candidates for interval cytoreductive surgery, that might have better survivals of advanced ovarian carcinoma.