间歇性肿瘤细胞减灭术中残余病灶变化对晚期卵巢上皮性癌术后化疗的预后评价

Prognostic evaluation of residual lesion changes in interval debulking surgery on postoperative chemotherapy for advanced epithelial ovarian cancer

目的 评价晚期卵巢上皮性癌（advanced epithelial ovarian cancer,AEOC）患者实施间歇性肿瘤细胞减灭术（interval debulking surgery,IDS）中与初次肿瘤细胞减灭术残余病灶变化对初次术后化疗疗效判断及评价预后的意义。方法 选择2006年1月至2013年8月高州市中医院妇科收治的52例AEOC患者,均行IDS。按与初次手术后残余病灶变化程度分为Ⅰ组（24例）、Ⅱ组（20例）及Ⅲ组（8例）。随访14~106个月,比较3组患者辅助化疗疗效、总生存时间（overall survival,OS）及疾病未进展生存时间（progression free survival,PFS）。结果 3组残余病灶评价化疗有效率、术后病理检查评价有效率以及复发率比较差异均有统计学意义（P〈0.05）。Ⅰ组患者的PFS、OS均优于Ⅱ、Ⅲ合并组。Ⅰ组与Ⅱ、Ⅲ合并组化疗中位总疗程数≥8次者的PFS及OS优于〈8次者。结论 AEOC患者在IDS中与初次手术残余病灶的变化能对辅助化疗的疗效进行初步判断并评价预后,可指导下一步的治疗策略。

Objective To investigate the prognostic evaluation significance of residual lesion changes in interval debulking surgery （IDS） on postoperative chemotherapy for advanced epithelial ovarian cancer （AEOC）. Methods A total of 52 cases with AEOC who underwent IDS in TCM Hospital of Gaozhou City from Jan 2006 to Aug 2013 were selected. All cases were assigned into group Ⅰ （ n = 24） ,group Ⅱ （ n = 20）, and group Ⅲ （ n = 8） based on the changes of residual lesions compared with that after first operation. After 14 ~ 106 months follow - up, the efficacy, overall survival time and progression free survival between 3 groups were compared. Results There were significant differences on clinical efficacy, pathological examination efficacy,recurrence rate among 3 group（P 〈0. 05）. PFS,OS in group Ⅰ were better than those in group Ⅱ ＋ Ⅲ （P 〈0. 05）. PFS and OS of patients with chemotherapycourses≥8 times in group Ⅰ and group Ⅱ ＋Ⅲ were better than patients with chemotherapy courses 〈 8 times. Conclusion The histopathological changes of tumor residual lesions in primary cytoredutive surgery and IDS may be of some value to evaluate the effectiveness of adjuvant chemotherapy in patients with AEOC ,which may contribute to the choice of adjuvant chemotherapy after IDS.