卵巢恶性肿瘤化疗研究进展

Advances in Chemotherapy for Ovarian Malignant Tumors

卵巢癌是妇科常见恶性肿瘤之一,由于卵巢位于盆腔的深部,体积较小,又缺乏典型症状及体征,发现时多数即为晚期,高复发率、高死亡率和低存活率对妇女的生活构成了严重的威胁。上皮性卵巢癌是最常见的类型,约占卵巢恶性肿瘤的50%~70%,对化疗较敏感。手术及化疗相联合是卵巢癌的主要治疗手段,化疗包括术前新辅助化疗、术后辅助化疗等,卵巢癌的一线化疗方案为以铂类+紫杉烷为主的联合化疗。随着对化疗的进一步深入研究发现,大多数患者为铂类敏感型,但约20%患者存在铂类耐药情况,并且无论患者对化疗的初始反应如何,大多数患者在疾病的过程中都不可避免会产生对铂治疗的抵抗,这对化疗的效果及患者的无进展生存期(PFS)、总生存期(OS)有很大影响。铂类耐药的因素有多种,可能与药物使用量增加、药物转运能力降低、新辅助化疗周期过长、DNA修复受损和凋亡过程改变等有关,但其主要机制尚需进一步研究。综述卵巢癌化疗现状及进展。

Ovarian cancer is one of the common malignant tumors in gynecology.Because the ovary is located in the deep part of the pelvic cavity,it is small in size and lacks typical symptoms and signs when they are diseased.When ovarian cancer is found,most of them are advanced.The high recurrence rate,high mortality rate and low survival rate of ovarian cancer pose a serious threat to women′s life.Among them,epithelial cancer is the most common type,accounting for 50%-70%of ovarian malignant tumors,and it is sensitive to chemotherapy.Surgery and chemotherapy are the main treatments for ovarian cancer.Chemotherapy includes preoperative neoadjuvant chemotherapy(NAC)and postoperative adjuvant chemotherapy.The first-line chemotherapy for ovarian cancer is combined chemotherapy based on platinum and paclitaxel.With the further study of chemotherapy,most patients were found to be platinum-sensitive while about 20%of patients had platinum resistance.Regardless of the initial response of patients to chemotherapy,most patients will inevitably have resistance to platinum treatment in the process of disease,which has a great influence on the effects of chemotherapy and the progression-free survival(PFS)and the overall survival(OS)of patients.There are many reasons for platinum resistance,including the increase of drug use,the decrease of drug transport capacity,long period of NAC,impaired DNA repair and changes in apoptotic processes,but the main mechanism needs further study.This is a review of the current situation and progress of chemotherapy for ovarian cancer.