术前辅助化疗在晚期卵巢癌治疗中的作用及疗效分析

Analysis on the Role and Effects of Neoadjuvant Chemotherapy in the Management of Advanced Ovarian Cancer

目的观察晚期卵巢癌术前辅助化疗的临床疗效,与常规辅助化疗对比探讨其在治疗晚期卵巢癌中的作用及意义。方法回顾性分析上海市嘉定区中心医院2008年1月—2012年1月收治的47例Ⅲ-Ⅳ期卵巢癌患者,其中25例采用术前辅助化疗加肿瘤细胞减灭术(NACT组),22例采用肿瘤细胞减灭术合并术后辅助化疗(ACT组),比较两组相关临床指标及疗效,评价新辅助化疗在晚期卵巢癌治疗中的作用及意义。结果 NACT组最佳减灭数17例(68.0%),显著高于ACT组8例(36.4%)(P<0.05);NACT组手术时长(193.57±31.19)min显著低于ACT组(219.36±29.78)min(P<0.05);术中平均出血量NACT组(452.12±89.76)ml显著低于ACT组(519.17±97.23)ml(P<0.05);NACT组治疗后CA125水平(175.24±39.48)U/ml显著低于ACT组(209.47±47.57U/ml)(P<0.05);NACT组总有效率(56.00%)与ACT组(40.91%)相比无统计学差异(P=0.302);NACT组中位生存时间22个月,与ACT组21个月无统计学差异(P=0.330);NACT组与ACT组1年生存率分别为68.0%和59.1%(P=0.971),3年生存率分别为32.0%和13.6%(P=0.094);logistic回归分析显示术后残留肿瘤直径大于2 cm(P=0.046)及术后CA125水平(P=0.041)是影响NACT化疗疗效的关键性因素。结论新辅助化疗可提高手术的有效率,缩短手术时长,减少术中出血,降低术后CA125水平,但未能改善疗效及延长患者生存时间。

OBJECTIVETo study the role and effects of neoadjuvant chemotherapy（NACT） in the management of advanced ovarian can-cer compare to adjuvant chemotherapy（ACT）. METHODS Is performed a retrospective analysis of 47 patients with advanced ovariancancer admitted to Jiading Central Hospital during 2008-2012. The conventional combined treatment of cytoreductive surgery was ap-plied in both the group that underwent NACT（n=25） and to the ACT group（n=22）. The effects of NACT were analyzed to compareACT group. RESULTS There was significant difference in the rate of the optimal cytoreductive surgery between patients who under-went the NACT（17 cases, 68.0%） and patients primarily treated with surgery（P〈0.05）. The operation time of NACT（193.57±31.19）minis shorter than ACT（219.36 ± 29.78min） group（P〈0.05）. Blood loss in surgery of NACT（452.12 ± 89.76）ml was less than ACT（519.17±97.23）ml（P〈0.05）. The level of CA125 post-surgery of NACT（175.24±39.48） U/mlwas lower than（ACT 209.47±47.57）U/ml（P〈0.05）. There was no significant difference in CR＋PR between NACT and ACT group（P=0.302）. There were no significant dif-ferences in median overall survival time between NACT group and surgery group（22 vs. 21 months, P=0.3298）.A 1-year survivalrate of NACT and ACT is 68% and 59.091%（P=0.971）,a 3-year survival rate of NACT and ACT is 32% and 13.636%（P=0.094）.Logistic regression analysis showed that patients with tumors larger than 2cm（P=0.046） and high CA125 level（P=0.041） were associ-ated with more resistance to NACT. CONCLUSION NACT could improve the efficiency of surgery, shorten the operation time, re-duce the loss of blood and depress the post-surgery CA125 level, however, it did not improve survival rates of advanced ovariancancer patients.