复发上皮性卵巢癌的综合治疗和预后因素

Recurrent epithelial ovarian carcinoma: combined treatment and prognostic factors

目的 :研究分析上皮性卵巢癌复发影响因素及其综合治疗 ,以期提高复发性卵巢癌的生存率。方法 :研究组为 1998年 1月— 2 0 0 0年 12月收治的 6 0例复发性卵巢上皮癌。研究组在二次细胞减灭术后 ,铂类敏感者选用TP方案 (紫杉醇 +顺铂 )或CC方案 (卡铂 +环磷酰胺 )。铂类耐药者采用TM方案 (紫杉醇 +丝裂霉素 )或VM方案(依托泊苷 +丝裂霉素 )。获得缓解后采用原方案 2 /3剂量维持治疗 ,平均 4— 6次化疗。对盆腔有残存肿瘤病例进行盆腔大野外放射治疗。在化放疗期间穿插选用干扰素、白介素 2。将 1986年 1月— 1997年 12月收治的 16 7例复发性卵巢上皮癌作为对照组 ,进行回顾性研究分析。对照组复发后采用以CAP为主的化疗配合中医中药治疗。结果 :研究组CR为 43.33%、PR为 45 .0 0 % ,均高于对照组的 2 .99%、7.78% (P =0 .0 0 0 ) ;研究组一年、二年、三年生存率为89.38%、79.6 9%、71.2 5 %分别高于对照组的 6 4.5 8%、40 .39%、31.2 0 % (P <0 .0 1) ;多因素分析结果显示 ,初次治疗因素中 ,首次细胞减灭术后残癌≥ 1cm、透明细胞癌患者预后较差 ,接受静脉化疗者预后较好。复发治疗因素中 ,术后接受放疗或二线化疗者预后较好。结论 :通过二次细胞减灭术、二线化疗、放疗及免疫治疗可提高疗效、延长生存?

Purpose:In order to improve the survival rate of recurrent ovarian carcinoma, influencing factors and the effects of combined therapy of recurrent epithelial ovarian carcinoma were investigated. Methods:From January 1998 to December 2000,60 patients with recurrent epithelial ovarian carcinoma were enrolled in the present study as research arm. The procedures of the combined treatment were as follows: After second cytoreductive surgery, platinum sensitive patients were treated with TP regimen (taxol+DDP) or CC regimen (CBP+CTX) and platinum resistant patients used TM regimen(taxol+MMC) or VM regimen(VP 16+MMC). Chemotherapy with 2/3 doses was continued after disease remission. Pelvic radiotherapy was performed for those with pelvic residual disease. IFN and/or IL 2 were administrated during chemotherapy and radiotherapy. 167 patients with recurrent epithelial ovarian carcinoma from January 1986 to December 1997, were retrospectively classified as control arm in this study. The patients were mainly treated with combined chemotherapy (CAP regimen) and traditional Chinese medicine applied as adjuvant therapy. Results:The rates of CR and PR in the research arm differed significantly from that in the control arm (43.33%, 45.00% vs. 2.99%, 7.78% P = 0.000). The 1 , 2 and 3 year survival rates of the research arm and control arm were 89.38%, 79.69%, 71.25% vs. 64.58%, 40.39%, 31.20% respectively ( P <0.01).Large residual tumor (diameter more than 1 cm) and clear cell carcinoma were poor prognostic factors according to Cox model analysis. Those treated with systemic chemotherapy, radiotherapy and second line chemotherapy had better survival. Conclusions:The treatment of recurrent cases including second cytoreduction surgery, second line chemotherapy, radiotherapy and immunotherapy was able to improve therapeutic efficacy and survival. Large residual tumor after first cytoreduction surgery (diameter more than 1 cm), histology types, systemic chemotherapy, radiotherapy and second line chemotherapy were prognostic factors.