新辅助化疗在晚期卵巢上皮性癌综合治疗中的临床研究

Clinical research of neoadjuvant chemotherapy on advanced epithelial ovarian cancer

目的探讨新辅助化疗(NACT)在晚期卵巢上皮性癌(卵巢癌)治疗中的临床意义。方法回顾性分析四川省肿瘤医院1999年1月至2008年12月收治的晚期卵巢癌(FIGOⅢ、Ⅳ期)患者161例,其中73例接受新辅助化疗+手术治疗+化疗(研究组),88例行初次肿瘤细胞减灭术+化疗(传统组)。结果研究组肿瘤手术切除率(即理想减瘤率)77.1%,传统组为56.8%,差异有统计学意义(P=0.012)。研究组术中失血量、术中输血量、术中补液量、腹水量和手术时间与传统组比较,差异均有统计学意义(P<0.05)。研究组平均无进展生存期(PFS)和总体生存期(OS)分别为22.7(7～63.5)个月和33.5(13.8～92.3)个月,传统组分别为21.7(4.3～61.2)个月和32.1(12.4～114.9)个月,两组比较差异无统计学意义(分别为P=0.082和P=0.293)。研究组和传统组5年生存率分别为17.8%和11.4%,差异无统计学意义(P=0.503)。结论行新辅助化疗+手术治疗+化疗治疗晚期卵巢上皮性癌的PFS、OS与仅行初次肿瘤细胞减灭术+化疗相似,但前者能明显提高肿瘤的手术切除率、减少术中出血量,同时并没有增加手术的并发症。

Objective To investigate the clinical significance of neoadjuvant chemotherapy（NACT） on advanced epithelial ovarian cancer. Methods Retrospective analysis of 161 patients with advanced epithelial ovarian cancer （FIGO Ⅲ、Ⅳ） of Sichuan Cancer Hospital between Jan. 1999 and Dec. 2008 were performed. Of these patients,73 cases were treated with neoadjuvant chemotherapy and interval debulking surgery and chemotherapy （research group）, while other 88 cases were underwent primary cytoreductive surgery and chemotherapy （traditional group）. All the cases were followed by plati- num-based chemotherapy after surgery. Results The rate of optimal surgical resection in research group and traditional group was 77.1% and 56. 8% respectively. There was a significant difference between the two groups（P = 0. 012）. There was a significant difference between two groups with intraoperative blood loss, blood transfusion,fluid transfusion, ascites volume, time of surgery （ P 〈 0.05 ）. The PFS （ progression-free suvival） and OS （ overall suvival） were 22. 7 months （7 63.5months） and 33.5months （13.8 -92. 3months）in research group,while the PFS and OS in traditional group were 21.7months （4. 3 -61.2months）and 32. 1 months （12. 4- 114. 9months）. There was no significant difference between two groups in PFS and OS （P =0. 082 and P =0. 293, respectively）. Five year survival rate of two groups were 17.8% and 11.4% in research group and traditional group, respectively without significant difference （ P = 0. 503 ）. Conclusion Although the study of PFS and OS in the traditional mode of surgery plus chemotherapy group compared with research group without results not significant difference, but the research group （NACT and surgery and chemotherapy） was able to obviously enhance tumor resection rate, decrease blood loss, while no increase in operative complications.