新辅助化疗联合间隔肿瘤细胞减灭术对晚期卵巢癌耐药性和生存时间的影响及耐药性影响因素分析

Effect of Neoadjuvant Chemotherapy Combined with Interval of Tumor Cells to Destroy the Loss(NACT-IDS) on Drug Resistance and Survival Time of Advanced Ovarian Cancer and Analysis of Drug Resistance

目的:分析新辅助化疗联合间隔肿瘤细胞减灭术(NACT-IDS)和初次肿瘤细胞减灭术(PDS)两种方法在治疗晚期上皮性卵巢癌时对其耐药性和生存时间的影响,并分析铂类耐药性的影响因素。方法:回顾性分析2008年1月至2014年6月就诊我院的354例晚期(FIGOⅢC~Ⅳ期)上皮性卵巢癌患者。根据治疗方法不同分为NACT-IDS组173例和PDS组181例,术后均辅以铂类药物化疗。全部治疗结束后,比较NACT-IDS组及PDS组患者对铂类药物的敏感性,并通过Logistic回归对铂类耐药的单因素、多因素影响进行分析,利用Kplan-Meier方法进行生存分析。结果:至随访结束,PDS组有149例(82.3%)复发,NACT-IDS组有132例(76.3%)复发,两组比较差异无统计学意义(P=0.162)。铂类耐药患者PDS组有26例(14.3%),NACT-IDS组有42例(24.3%),两组比较差异有统计学意义(P=0.018)。对铂类耐药性作单因素分析发现治疗方法、FIGO分期、总化疗周期与铂耐药性有关(P<0.05)。而多因素分析发现新辅助化疗不是影响铂耐药性的独立危险因素。NACT-IDS组与PDS组中位无病生存期(DFS)(13.5月vs 15.4月,P=0.475)、总生存期(OS)(51.7月vs 46.2月,P=0.147)比较,差异均无统计学意义。结论:NACT-IDS治疗晚期卵巢癌时增加了对铂类药物的耐药性,但对生存时间无明显影响。新辅助化疗不是铂类耐药性的独立危险因素。

Objective： To analyze the drug resistance and survival of advanced epithelial ovarian cancer patients who were treated with neoadjuvant chemotherapy combined interval debulking surgery（ NACT-IDS） and primary debulking surgery（ PDS）,and to investigate the influencing factor of platinum resistance.Methods： Retrospectively reviewed 354 cases of advanced（ FIGO stage Ⅲ C-Ⅳ） epithelial ovarian cancer patients from January 2008 to June 2014 treated at The Affiliated Tumor Hospital of Harbin Medical University.The patients were divided into two groups： NACT- IDS（ 173 patients）; PDS（ 181 patients）.All patients were treated with platinum based chemotherapy after operation.The survival of patients and the sensitivity to platinum were analyzed.Results： By the end of follow-up,149 cases in PDS group（ 82. 3%） and 132 cases in NACT-IDS group（ 76. 3%） were defined as cancer recurrence,with no significant difference（ P = 0. 162）. Patients with platinum resistance in PDS group（ n = 26,14. 3%） was lower than that in NACT-IDS group（ n = 42,24. 3%）,with statistically significant difference（ P〈0. 05）. The single factor analysis of platinum resistance showed that the treatment method,FIGO stage and chemotherapy cycle was related to platinum resistance.Multivariate analysis revealed that neoadjuvant chemotherapy was not an independent risk factor for platinum resistance. No difference was observed in progression-free survival（ 13. 5 vs 15. 4 months,P = 0. 475） and overall survival（ 51. 7 vs 46. 2 months,P = 0. 147） between NACT-IDS group and PDS group.Conclusions： Neoadjuvant chemotherapy can increase the risk of patients＇ platinum resistance,but it＇s not the independent risk factor.