新辅助化疗在ⅢC~Ⅳ 期卵巢癌治疗中的临床疗效评估

Clinical evaluation on the efficacy of neoadjuvant chemotherapy for stageⅢC-Ⅳovarian cancer

目的:评价新辅助化疗(NACT)在ⅢC~Ⅳ期卵巢癌患者治疗中的临床疗效并进行生存分析。方法:对2013~2018年诊断和治疗的ⅢC~Ⅳ期卵巢癌患者进行回顾性研究,筛选标准遵循FIGO分期。满足研究条件的卵巢癌患者240例,NACT组患者58例先接受NACT治疗再行间歇性肿瘤细胞减灭术(IDS),术后完成余下化疗;初始肿瘤细胞减灭术(PDS)组患者182例接受PDS治疗,术后行辅助化疗。对比分析两组临床资料。结果:两组患者最大原发肿瘤直径、残病灶大小差异均有统计学意义(P<0.05)。NACT组恶性胸水发生率(24.14%)高于PDS组(12.64%),NACT组血清CA125水平高于PDS组(P<0.05)。PDS组患者术后心血管并发症的发生率(12.64%)高于NACT组(3.45%)(P<0.05)。NATC组患者术中出血量及输血率均低于PDS组(P<0.05)。NACT组患者术中需扩大手术范围率(如上腹部手术及肠切除术)低于PDS组(P<0.05)。NACT组患者手术时间以及住院时间少于PDS组(P<0.05)。PDS组的无进展生存期(PFS)优于NACT组(P<0.05),而NACT组的总生存期(OS)优于PDS组(P<0.05)。NACT R0组的PFS优于PDS R0和R1组(P<0.05);NACT R0组的OS短于PDS R0组(P<0.05),而NACT R0组的OS长于PDS R1组(P<0.05)。结论:NACT可提高ⅢC~Ⅳ期卵巢癌手术的缩瘤满意度,降低术后并发症的发生率。与接受PDS的患者相比,NACT延长了患者的PFS,而与接受PDS未完全清除的患者相比,接受NACT的患者OS能够有所延长。

Objective:To evaluate the clinical efficacy and survival of neoadjuvant chemotherapy(NACT)in patients with stageⅢC-Ⅳovarian cancer.Methods:The cases were initially screened by FIGO staging.Totally,240 eligible cases of stageⅢC-Ⅳovarian cancer diagnosed and treated in our hospital were included from 2013 and 2018,and divided into neoadjuvant chemotherapy group(NACT group,n=58)and primary debulking surgery group(PDS group,n=182).Patients in NACT group received NACT,followed by intermittent tumor cell reduction(IDS),and completed the remaining chemotherapy after surgery.Those in PDS group were treated by initial PDS,then undergone postoperative chemotherapy.The clinical data were retrospectively analyzed and compared in the two groups of patients.Results:There was significant difference in the diameter of the largest primary tumor and the size of residual lesions between groups(P<0.05).The incidence of malignant pleural effusion and serum CA125 level were higher in NACT group than in PDS group(24.14%vs.12.64%,both P<0.05).Patients in PDS group had higher incidence of postoperative cardiovascular complications than those in NACT group(12.64%vs.3.45%,P<0.05).Intraoperative blood loss and blood transfusion rate were lower in NATC group than in in PDS group(both P<0.05).The probability of requiring extended resection,such as upper abdominal surgery and enterectomy,was lower in NACT group than in PDS group(P<0.05).Patients in NACT group had shorter operative time and hospital stay as well as better progression-free survival(PFS)and overall survival(OS)than those in PDS group(all P<0.05).The PFS results of NACT R0 group were better than those of PDS R0 and R1 groups(P<0.05),and OS of NACT R0 group was lower than that of PDS R0 group(P<0.05),yet the OS of NACT R0 group was higher than that of PDS R1 group(P<0.05).Conclusion:NACT can not only improve the probability of satisfied reduction of tumor size in patients with stageⅢC-Ⅳovarian cancer,but also reduce the incidence of postoperative complications.Importantly,NACT may lead to extended PFS compared to patients treated by PDS,and patients treated by NACT can have longer OS than those with incomplete clearance following PDS.