Ⅳ期卵巢上皮性癌肿瘤细胞减灭术及预后因素的临床研究

Cytoreductive Surgery in the Management of Stage IV Epithelial Ovarian Cancer

目的 探讨Ⅳ期卵巢上皮性癌的肿瘤细胞减灭术的意义和预后因素。方法 回顾性分析我院 1986年 1月至 1997年 12月 ,经手术病理分期的Ⅳ期卵巢上皮性癌 71例 ,其中切净组 (残留灶≤ 1cm) 30例 ,未切净组 (残留灶 >1cm) 4 1例。结果 手术切净率为 42 .3%。Ⅳ期卵巢上皮性癌各转移部位中 ,锁骨上淋巴结转移和胸膜转移患者切净组的预后明显好于未切净组 (P <0 .0 5 )。Ⅳ期卵巢上皮性癌的总 5年生存率为 6 .1% ,其中切净组与未切净组的 5年生存率分别为 13.7%和 0 .0 % ,中位生存期分别是 2 3个月和 9个月 ,分别比较 ,差异均有极显著性 (P <0 .0 0 1)。COX模型逐步回归结果表明 ,残留灶直径 >1cm和腹水是预后的危险因素 (P <0 .0 5 )。化学治疗与预后无关。结论 肿瘤细胞减灭术对Ⅳ期卵巢上皮性癌 ,尤其是锁骨上淋巴结和胸膜有转移者有肯定的治疗价值。

Objective To determine the role of cytoreductive surgery in patients with stage Ⅳ epithelial ovarian cancer. Methods From Jan. 1986 to Dec. 1997, 71 patients with stage Ⅳ epithelial ovarian cancer who were surgically treated in our hospital were retrospectively reviewed. Survival was calculated by Kaplan Meier method with differences in survival estimated by Log rank test. Independent prognostic factors were identified by the COX′s stepwise regression model. Results Thirty (42.3%) of 71 patients were successfully debulked (≤1 cm) at the time of initial surgery. The estimated 5 year total survival rate was 6.1%. There was a significant difference in survival between patients optimally (13.7%) vs. suboptimally (0.0%) cytoreduced, with an estimated median survival of 23 months in optimal group vs. 9 months in suboptimal group ( P <0.001). When the variables were factorized, optimal cytoreduction could get the greatest benefit. Only in patients with malignant pleural effusion or positive supraclavicular lymph node. Multivariate analysis revealed that size of residual disease and ascites were independent factors for both overall and progression free survival ( P <0.05). Conclusions Optimal cytoreductive surgery is an important determinant of survival in women with stage Ⅳ epithelial ovarian cancer, especially in those with malignant pleural effusion or positive supraclavicular lymph node pathology.