晚期上皮性卵巢癌患者“间歇性肿瘤细胞减灭术”手术适应证的探讨

A discussion about indications of interval debulking surgery in patients with advanced epithelial ovarian cancer

目的:探讨间歇性肿瘤细胞减灭术(IDS)的适应证。方法:采用回顾性病例对照研究,分析2000年1月至2009年12月间71例初次肿瘤细胞减灭术不满意的ⅢC～Ⅳ期卵巢上皮癌(包括原发性腹膜癌,原发性输卵管癌)患者的资料。A组(n=41)初次减灭术后单纯化疗6～8疗程;B组(n=30)经3～4个疗程化疗后行间歇性肿瘤细胞减灭术,然后继续化疗4～6疗程。化疗方案均为铂类为基础的联合化疗。两组患者的化疗方案和疗程无差异。通过比较两组患者的临床特征、手术及生存情况,以及B组患者IDS术前CA125、B超检查与术后病理结果的对应关系,总结IDS的适应证。结果:B组30例患者中23例(76.7%)最终达到满意减瘤,共有11例术后病理结果为阴性,术前CA125或B超对病理结果阳性预测的敏感度差,CA125的特异性达100%。CA125联合B超的预测准确率为70%。A、B组的五年生存率(P=0.790)、OS(P=0.254)和PFS(P=0.289)均无显著性差异。B组中无肉眼残留病灶患者的PFS和OS较A组有明显延长的趋势。结论:间歇性肿瘤细胞减灭术主要适应证是:初次肿瘤细胞减灭术采用"基本术式",3个疗程化疗后部分缓解,CA125仍异常;或CA125恢复正常,最好经PET-CT或增强CT明确有残留病灶。残留病灶有可能通过再次手术切除干净,达到无肉眼残留,这部分患者有可能生存获益。

Objective：To study and discuss indications of interval debulking surgery（IDS） undergone by patients with advanced epithelial ovarian cancer（EOC）.Methods：71 consecutive patients with stage ⅢC and Ⅳ EOC（including primary peritoneal carcinoma or primary fallopian tube carcinoma） who underwent suboptimal primary debulking surgery and platinum-based chemotherapy were enrolled from Jan.2000 to Dec.2009.They were divided into 2 groups：group A consists of 41 patients who received 6 to 8 courses of platinum-based chemotherapy after suboptimal PDS.Group B was made by the other 30 patients who received IDS following suboptimal PDS.Indications of IDS was discussed by comparing all patients＇clinical characteristics,perioperative situation and prognosis.It was also necessary to check the CA125 level and B ultrasound both before and after IDS in group B,then compared them with pathological consequence.Results：23 patients（76.7%,23/30） from group B had gone through optimal debulking,among which there were 11 who got a negative pathological result.The sensitivity of both CA125 level and B ultrasound before IDS were poor,while the specificity of CA125 level could reach to 100%.The accuracy of CA125 combined with B ultrasound to predict pathological consequence is 70%.The five-year survival rate（P=0.790）,OS（P=0.254）,PFS（P=0.289） were close for both groups.For those who got no gross residual in group B seem to have a longer PFS and OS than those in group A.Conclusions：The major indications of IDS are concluded as follows：（1） basic dubulking in PDS;（2） partial remission after 3 courses of chemotherapy with abnormal CA125 level;（3） normal CA125 with positive consequence in PET-CT/E-CT;（4） residual lesion could be removed in further IDS.