64例Ⅳ期上皮性卵巢癌的临床分析

An analysis of 64 cases with stage IV epithelial ovarian cancer

目的研究IV期上皮性卵巢癌的临床病理特征及预后影响因素,为Ⅳ期上皮性卵巢癌的治疗提供参考。方法回顾性分析1997年1月至2009年12月中山大学肿瘤医院收治的经手术及病理确诊为Ⅳ期上皮性卵巢癌患者共64例的临床病例资料及随访资料,其中32例患者直接行手术治疗(PDS),32例患者先行新辅助化疗(NACT),再接受中间性肿瘤细胞术(IDS)。分析各临床病理因素及治疗方法对预后的影响。结果未发现年龄、治疗前CA125水平、病理类型、肿瘤分化程度、原发肿瘤大小、转移类型、是否新辅助化疗及手术满意程度等与总生存时间相关(P>0.05)。仅因胸水细胞学阳性诊断为Ⅳ期的患者行新辅助化疗+中间性肿瘤细胞减灭术者总生存时间中位数较直接行手术治疗者长39个月(P=0.020)。新辅助化疗与手术的满意程度相关(P<0.001)。结论在经过评估无法行满意的肿瘤减灭术的患者,新辅助化疗+中间性肿瘤细胞减灭术可考虑成为Ⅳ期卵巢癌治疗的选择之一。

Ab Objective To investigate the treatment methods and other prognostic factors of stage Ⅳ epithelial ovarian cancer. Methods Clinical data of the 64 patients with stage Ⅳ epithelial ovarian cancer treated in Sun Yat-sen University Cancer Center from January 1997 to December 2009 were retrospectively analyzed. Thirty-two patients were treated with primary debulking surgery （PDS） while the other 32 patients underwent neoadjuvant chemotherapy followed by interval debulking surgery （NACT-IDS）.Results Both univariate and multivariate analysis revealed that age, primary serum CA125 level, histology,size of the original tumor, type of metastasis, treatment methods and optimal cytoreductive surgery were not important prognostic factors of survival （P〉0.05）. Patients having stage Ⅳ disease by pleural cytology had survival benefit when treated with NACT-IDS （median survival, 74 months vs. 35 months; P=0.020）. NACT was correlated with optimal cytoreductive surgery（P〈0.001）. Conclusions NACT-IDS for stage Ⅳ ovarian cancer resulted in higher rates of optimal cytoreductive surgery and equivalent OS compared to PDS. NACT-IDS may be considered as an alternative treatment method for women with stage IV epithelial ovarian cancer, especially in those with positive pleural cytology only.