新辅助化疗联合肿瘤细胞减灭术治疗晚期上皮性卵巢癌的效果及对血清人附睾分泌蛋白4、糖类多肽抗原125水平的影响

Efficacy of neoadjuvant chemotherapy combined with cytoreductive surgery for advanced epithelial ovarian cancer and its influence on human epididymis protein 4 and cancer antigen 125 levels

目的 探讨新辅助化疗联合肿瘤细胞减灭术治疗晚期上皮卵巢癌的临床效果,以及对血清人附睾分泌蛋白4（human epididymis protein 4,HE4）、糖类多肽抗原125（cancer antigen 125,CA125）水平的影响.方法 选取2010年1月至2014年1月福建医科大学附属泉州第一医院收治的128例晚期卵巢癌患者临床资料,根据治疗方案的不同,将128例患者分为观察组68例和对照组60例.观察组患者给予新辅助化疗联合肿瘤细胞减灭术与常规化疗,对照组采用肿瘤细胞减灭术与常规化疗相结合的方案.比较两组患者的临床有效率、手术时间、失血量、腹水量、并发症、住院时间,以及血清HE4以及CA12水平的变化,随访两组患者1、3年生存率并在术后1、3年检测HE4和CA125浓度.结果 观察组的满意减瘤例数显著高于对照组[73.53％（50/68）与51.67％（31/60）,χ^2=6.56,P〈0.05].观察组近期疗效显著优于对照组（Z=5.79,P〈0.05）.观察组患者的手术时间、失血量、腹水量、并发症发生数、住院时间均显著低于对照组[手术时间：（119.6±39.1）min与（177.3±45.6）min,t=7.71,P〈0.05;失血量：（378.9±88.4）ml与（616.3±110.8）ml,t=13.47,P〈0.05;腹水量：（678.5±205.1）ml与（1372.4±405.8）ml,t=12.42,P〈0.05;并发症发生率分别为13.2％（9/68）与31.7％（19/60）,χ^2=6.34,P〈0.05;住院时间：（10.4±3.2）d与（15.3±3.1）d,t=8.77,P〈0.05].两组患者治疗前HE4、CA125比较差异无统计学意义（P均〉0.05）,化疗后两组患者HE4、CA125水平较治疗前均显著降低,观察组显著低于对照组[HE4：（98.3±28.9）pmol/L与（153.2±44.1）pmol/L,t=8.42,P〈0.05;CA125：（35.3±14.8）kU/L与（48.3±14.2）kU/L,t=5.05,P〈0.05].观察组发生骨髓抑制和消化道反应较对照组更为严重（χ^2=分别为4.09,4.87,P均〈0.05）.两组患者的1年生存率差异无统计学意义[86.76％与81.67％,χ^2=0.63,P〉0.05],1年随访时,观察组患者HE4、CA125水平均明显低于对照组[HE4：（112.2±33.7）pmol/L与（189.4±39.6）pmol/L,t=10.95,P〈0.05;CA125：（51.2±14.2）kU/L与（59.7±18.6）kU/L,t=2.69,P〈0.05].观察组患者3年生存率明显高于对照组[55.88％与38.33％,χ^2=3.94,P〈0.05],HE4、CAl25水平明显低于对照组[HE4：（166.5±45.5）pmol/L与（245.7±51.8）pmol/L,t=6.25,P〈0.05;CA125：（77.4±18.5）kU/L与（94.4±16.7）kU/L,t=3.61,P〈0.05].结论 新辅助化疗联合肿瘤细胞减灭术能够有效提高晚期上皮卵巢癌的临床有效率,改善患者预后.

Objective To explore the clinical effect of neoadjuvant chemotherapy combined with tumor cell subtraction in the treatment of advanced epithelial ovarian cancer,as well as the effects on serum epididymal secretory protein 4 （ Human Epididymis protein 4,HE4） ,and glucose polypeptide antigen 125 （ cancer antigen 125,CA125 ） . Methods From January 2010 to January 2014, patients with advanced ovarian cancer from Quanzhou First Hospital Affiliated to Fujian Medical University were selected. According to the difference of clinical treatment plan,128 patients with advanced epithelial ovarian cancer were divided into the observation group （ 68 cases ） and the control group （ 60 cases ） . The patients in the observation group were given neoadjuvant chemotherapy combined with tumor cytoreductivesurgery, and the control group was treated with tumor cytoreductivesurgery and conventional chemotherapy. The clinical efficacy, operation time, blood loss volume, ascites volume, complication, hospitalization time, HE4and CA125 were compared between the two groups. Also 1 year,3 year survival rate,HE4 and CA125 levels of the two groups were analyzed. Results The number of satisfactory tumor reduction cases in observation group was significantly higher than that in control group（ 73. 53%（ 50/68） ,51. 67%（ 31/60） ,χ^2=6. 56,P〈0. 05） . The short-term effect of observation group was significantly better than that in control group（ Z=5. 79,P〈0. 05） . The operation time,blood loss volume,ascites volume,complication and hospitalization time of observation group were significantly lower than those in control group （operation time：（119. 6±39. 1） min vs. （177. 3±45. 6） min,t=7. 71,P〈0. 05;blood loss：（378. 9 ±88.4） ml vs. （616.3±110.8） ml,t=13.47,P〈0.05;ascites volume：（678.5±205.1） ml vs. （1372.4 ±405. 8） ml,t=12. 42, P〈0. 05;complication： 13. 2%（ 9/68） vs. 31. 7%（ 19/60）,χ^2= 6. 34, P〈0. 05;hospitalization time：（10. 4±3. 2）d vs. （15. 3±3. 1）d,t=8. 77,P〈0. 05）. There was no significant difference in HE4 and CA125 between the two groups before treatment （ P〉0. 05） . After chemotherapy,the level of HE4 and CA125 decreased significantly in the two groups after chemotherapy,and the observation group was significantly lower than the control group （HE4： （98. 3±28. 9） pmol/L vs. （153. 2±44. 1） pmol/L,t=8. 42,P〈0. 05;CA125：（35. 3±14. 8） vs. （48. 3±14. 2） ） kU/L,t=5. 05,P〈0. 05）. The myelosuppression and digestive tract reaction in the observation group were more serious than those in control group （χ^2=4. 09,4. 87,P〈0. 05） . There was no significant difference in the 1 year survival rate between the two groups （ 86. 76% vs. 81. 67%,χ^2=0. 63, P〉0. 05 ） . After 1 years of follow-up, the levels of HE4 and CAl25 in the observation group were significantly lower than those in the control group （HE4：（112. 2±33. 7） pmol/L vs. （189. 4±39. 6） pmol/L,t=10. 95,P〈0. 05;CA125：（51. 2±14. 2） kU/L vs. （59. 7±18. 6） kU/L,t=2. 69,P〈0. 05）. 3 year survival rate in observation group was significantly higher than that in control group （ 55. 88% vs. 38. 33%,χ^2=3. 94, P〈0. 05）. The levels of HE4 and CAl25 were significantly lower than those in control group（HE4：（166. 5±45. 5） pmol/L vs. （245. 7±51. 8） pmol/L,t=6. 25,P〈0. 05;CA125：（77. 4±18. 5） kU/L vs. （94. 4±16. 7） kU/L,t=3. 61,P〈0. 05） . Conclusion Neoadjuvant chemotherapy combined with cytoreductive surgery can effectively improve the clinical efficiency and improve the prognosis of patients with advanced epithelial ovarian cancer.