卵巢癌肉瘤临床病例分析

Retrospective clinical analysis of ovarian carcinosarcoma

目的总结卵巢癌肉瘤的各项临床病理特征、治疗方法及预后。方法回顾性分析1977年1月～2007年12月在我院就诊的卵巢癌肉瘤的各项临床特点及生存结果，采用SPSS15．0软件进行统计学分析。结果共收集病例28例，总中位生存时间19个月，1年和3年生存率分别是74．1％和31．7％。Ⅰ～Ⅱ期和Ⅲ～Ⅳ期患者的中位生存时间分别是35个月和15个月（P=0．03）。满意减瘤和非满意减瘤者的中位生存时间分别是35个月和9个月（P=0．001）。22例患者接受了术后辅助化疗，其中紫杉醇联合卡铂（TC）化疗6例，其他含铂联合化疗11例，非铂类化疗5例。三组患者的化疗缓解率分别是83．3％（5／6，CR5例），54．5％（6／11，CR4例，PR2例）和60．0％（3／5，CR3例）。三组患者的6个月无复发生存率分别是83％、36％和60％；3年生存率分别是67％、10％和60％。结论卵巢癌肉瘤预后差，分期和残存肿瘤的状况为预后影响因素。Tc方案作为术后辅助化疗可能是有效的化疗方案之一。

Objective To discuss the efficacy of adjuvant chemotherapy for ovarian carcinosarcoma. Method We reviewed the hospital records and pathology of the patients with ovarian carcinosarcoma treated at Cancer Hospital, Chinese Academy of Medical Sciences between January 1977 and December 2007. Statistical analysis was performed using SPSS 15.0 software. Kaplan Meier method was adopted. Result A total of 28 cases were enrolled in the study. The median overall survival was 19 months. 1-year and 3-year survival rates were 74. 1% and 31.7% , respectively. Univari- ate analysis showed that stage （P = 0.03 ） and residual disease （P = 0. 001 ） were related to survival. Among patients receiving post-operative adjuvant chemotherapy, 22 were eligible for analysis, including 6 treated with paclitaxel/carbo- platin （TC）, 11 with other platinum-containing regimens （OPC）, and 5 with non-platinum containing regimens （NPC）. Response rates of TC, OPC and NPC were 83.3% （5 CR）, 54.5 % （4 CR, 2 PR） and 60.0% （ 3 CR）, re- spectively. 6-month disease-free survival of these 3 groups were 83% , 36% and 60% ; 3-year survival were 67% , 10% and 60% , respectively. Conclusion Ovarian carcinosarcoma had a very poor prognosis. Advanced stage and su- boptimal cytoreduction were associated with poor prognosis. Adjuvant TC chemotherapy might be one of the effective regi- mens to this tumor.