卵巢上皮性癌复发规律的探讨

Study of recurrent characteristics of epithelial ovarian carcinoma

目的：了解卵巢上皮性癌的复发规律，探讨降低复发率的可能措施。方法：回顾性分析１９８５年１月至１９９４年１２月在我院经细胞减灭术后肿瘤残留灶≤２ｃｍ的卵巢上皮癌Ⅰ－Ⅲ期１８９例临床资料，其中Ⅰ期 ８１例、Ⅱ期１９例、Ⅲ期８９例。９７例术后按计划完成铂类药物为主的化疗。结果：１８９例中７０例复发，总的复发率为３７．０％。 １年以内２年以内、３年以内和５年以上的复发患者各占 ４１．４％、６５．７％、７４.３％和 ８．６％。 Ｉ期和 Ⅱ、Ⅲ期的复发率分别为１２.３％和５５．６％（Ｐ＜０.０１）。完成化疗计划者和未完成者的复发率分别为２７．６％和４６.７％（Ｐ＜０．０１）。对年龄、病理类型、手术分期和术后化疗四个因素进行多因素Ｌｏｇｉｓｔｉｃ回归分析表明，手术分期和化疗是影响复发的显著性因素（Ｐ分别＜０．０１和０.０５）。结论：卵巢上皮性癌术后复发大多在３年之内。复发率与手术分期及术后化疗密切相关。早期诊断和术后有计划的化疗可望减少复发，改善预后。

Objective: To investigate the recurrent characterstics of epithelial ovarian cancer and study the possible method to reduce recurrence. Method: The clinical data of 189 cases of stage Ⅰ-Ⅱ epithelial ovarian carcinoma patients (stage I 81cases, stage Ⅱ 19, and stage Ⅲ 89) who were admitted to our hospital during Jan 1, 1985 to Dec 31, 1994 and received optimal surgery (residual≤2cm) were analyzed retrospectively. Ninty-seven cases have finished post operative chemotherapy plan. Seventy out of 189 cases relapsed. Results: The overall recurrent rate was 37. 0% and the recurrency of ≤1 year post-operation, ≤ 2 years, ≤3 years and > 5 years was 41.1%, 65.7%, 74.3% and 8.6%, respectively. Twelve point three percent of stage I patients relapsed and 55.6% in stage Ⅱ, Ⅲ (P < 0. 01 ). The recurrent rate of those who have finished post-operative chemotherapy and those who haven't was 27. 6% and 46. 7% respectively (P < 0. 01). Multivariate Logistic regression with age, pathological type, stage and post-operative chemotherapy showed that stage and chemotherapy were the significant factors for recurrence (P < 0. 01 and P<0.05 ). Conclusion: Most epithelial ovarian cancer patients relapse within 3 years after operation. The recurrent rate is closely related to stage and chemotherapy. Early diagnosis and enough courses of post-operation chemotherapy are expected to decrease recurrence and improve prognosis.