新辅助化疗联合间歇性肿瘤细胞减灭术治疗Ⅲ期卵巢高级别浆乳癌的疗效及对患者生存质量的影响

Efficacy of neoadjuvant chemotherapy combined with interval debulking surgery on patients with stage Ⅲ high grade papillary serous ovarian cancer and its impact on quality of life

目的 探讨新辅助化疗联合间歇性肿瘤细胞减灭术（NACT-IDS）治疗Ⅲ期卵巢高级别浆乳癌的临床疗效及对患者生存质量的影响.方法 304例晚期卵巢癌（FIGO Ⅲ）患者中,168例行新辅助化疗＋手术治疗＋化疗（研究组）,136例行初次肿瘤细胞减灭术＋化疗（对照组）.比较两组手术时间、术中出血量、满意减瘤率、术中输血率、术后盆腹腔感染、临床疗效、腹腔镜手术率、复发及生存率等指标,评价手术疗效.结果 研究组术前糖类抗原125（CA125）平均水平为2 531 U/ml,对照组为1 431 U/ml,两组比较差异有统计学意义（P＜0.05）.研究组满意减瘤率为89.3％,高于对照组的77.9％;术中失血量、手术时间、复发率[235.09 ml、207.38 min、4.8％]均低于对照组[788.68ml、241.47 min、27.2％];腹腔镜手术率（95.84％）高于对照组（53.68％）,术中输血率（4.8％）低于对照组（27.2％）,差异均有统计学意义（P均＜ 0.05）.研究组平均无进展生存期（PFS）为23.200（6.100～38.000）个月,高于对照组的20.868（4.000～ 33.000）个月（P =0.046）;研究组和对照组总生存期（OS）[37.596（11 ～60）个月比35.053 （6 ～54）个月]比较差异未见统计学意义（P=0.113）;研究组平均总费用（8.97万）低于对照组（10.04万）,P＜0.05.研究组1、3年生存率分别为92.26％、72.61％,对照组分别为88.23％、52.94％.不同治疗方案的心理影响：研究组可能抑郁53例（31.5％）,肯定抑郁96例（57.1％）,严重抑郁12例（7.2％）;对照组可能抑郁47例（34.6％）,肯定抑郁64例（47.1％）,严重抑郁16例（11.7％）,两组可能抑郁及以上患者比例比较差异未见统计学意义（P =0.235）.结论 新辅助化疗联合间歇性肿瘤细胞减灭术治疗晚期卵巢癌,能明显提高肿瘤的满意减瘤率,减少术中出血量,缩短手术时间,降低剖腹手术率及术并发症发生率,同时可提高临床疗效,降低肿瘤复发率.

Objective To investigate the efficacy of neoadjuvant chemotherapy combined with interval debulking surgery （NACT-IDS） on patients with stage Ⅲ high grade papillary serous ovarian cancer and its impact on quality of life.Methods A total of 304 patients with advanced ovarian cancer （FIGO Ⅲ） were selected,of which 168 patients underwent neoadjuvant chemotherapy ＋ surgery ＋ chemotherapy （study group）,136 patients underwent primary debulking surgery ＋ chemotherapy （control group）.Operation time,intraoperative blood loss,ideal reduction rate,rate of intraoperative blood transfusion,rate of pelvic abdominal infection,clinical efficacy,laparoscopic surgery rate,recurrence rate and survival rate of the two groups were compared to assess the therapeutic effect.Results The average level of preoperative carbohydrate antigen 125 （CA125） was 2 531 U/ml in study group and 1 431 U/ml in control group,the difference was statistically significant （P 〈 0.05）.The ideal reduction rate was 89.3% in study group and 77.9% in control group,the difference was statistically significant （P =0.007）.The blood loss,operation time and recurrence rate in study group （235.09 ml,207.38 min,4.8%） were lower than those in control group （788.68 ml,241.47 min,27.2%）,all P 〈0.05.The rates of laparoscopic surgery in study group （95.84%） was higher than that in control group （53.68%） and blood transfusion rate of study group （4.8%） was lower than that of control group （27.2%）,both P 〈 0.05.The mean progression-free survival （PFS） of study group and control group was 23.200（6.100-38.000） months and 20.868 （4.000-33.000） months,respectively,and there was a significant difference between the two groups in PFS （P =0.046）.The overall survival （OS） of study group was 37.596 （11.000-60.000） months and that was 35.053 （6.000-54.000） months of control group,the difference was not statistically significant （P =0.113）.The average cost was 89 700 RMB in study group and 100 400 RMB in control group,the difference was statistically significant （P 〈 0.05）.The 1-year and 3-year survival rates were 92.26% and 72.61% in study group and were 88.23% and 52.94% in control group.Psychological impact of different treatments：53 cases （31.5%） may have depression,96 cases （57.1%） definitely had depression,12 cases （7.2%） had sever depression in study group;in the control group,47 cases （34.6%） may have depression,64 cases （47.1%） definitely had depression,16 cases （11.7%） had severe depression;there was no significant difference in the number of people who had depression or worse between the two groups （P =0.235）.Conclusions NACT-IDS in the treatment of advanced ovarian cancer can significantly improve the surgical resection rate of tumor,reduce intraoperative blood loss,shorten the operation time,reduce the rate of laparotomy,incidence of surgical complications,tumor recurrence rate and improve the clinical effect.