化疗疗程数对初治满意减瘤的晚期卵巢浆液性癌患者的预后分析

Prognostic analysis of the chemotherapy cycles in patients with advanced ovarian serous carcinoma and optimal debulking surgery

目的探讨对于初治满意减瘤且初始治疗结束达到临床缓解的晚期卵巢浆液性癌患者,增加化疗疗程数是否可使生存获益。方法纳入标准为重庆大学附属肿瘤医院妇科肿瘤中心2013年1月至2017年1月收治的晚期(Ⅲ~Ⅳ期)卵巢高级别浆液性癌患者,初始肿瘤细胞减灭术或间歇性肿瘤细胞减灭术达到满意减瘤(R0或R1),且初始治疗结束达到完全缓解或部分缓解。将新辅助化疗与术后辅助化疗疗程数相加,≤6个周期者为研究组,>6个周期者为对照组,各筛选入组30例患者,回顾性分析其临床病理资料,主要研究终点为无进展生存期(PFS),次要研究终点为总生存期(OS)。结果研究组中患者平均发病年龄为(54.3±9.6)岁,19例(63.3%)患者术前行新辅助化疗(NACT),对照组患者平均发病年龄为(52.3±8.3)岁,23例(76.7%)行NACT,两组患者年龄、术前CA125水平、是否行NACT、手术病理分期、手术范围、残存肿瘤及术后化疗等比较,差异无统计学意义(均P>0.05)。随访截止至2020年1月,对照组随访时间为(39.0±15.3)个月,长于研究组的(26.2±5.1)个月。初始治疗结束2年内,研究组有16例(53.3%)患者复发,3例(10.0%)患者死亡;对照组22例(73.3%)患者复发,4例(13.3%)患者死亡,两组比较差异无统计学意义(均P>0.05)。研究组和对照组的2年PFS分别为41.3%和26.7%,两组比较差异无统计学意义(P=0.108),2年OS分别为89.6%和83.3%,两组比较差异亦无统计学意义(P=0.887)。结论对于初治手术满意减瘤、初始治疗结束达到临床缓解的晚期卵巢高级别浆液性腺癌患者,化疗总疗程数>6个并不能延长患者的无进展生存时间,但仍需开展前瞻性临床研究进一步证实。

Objective To explore if increasing the chemotherapy cycles can improve the survival of patients with advanced ovarian serous carcinoma who have received the optimal cytoreduction and achieved clinical remission after initial treatment.Methods We conducted a single-institution retrospective cohort study on patients with advanced ovarian high-grade serous carcinoma(stageⅢ-Ⅳ)treated from January 2013 to January 2017 in Chongqing University Cancer Hospital.The primary or interval debulking surgery was optimal with the residual tumor nodules less than 1 cm(R0 or R1).Clinical remission(CR/PR)was achieved after initial treatment.Add the number of neoadjuvant chemotherapy(NACT)and postoperative adjuvant chemotherapy cycles.The study group was with less than 6 cycles and the control group with more than 6 cycles.Each group included 30 patients.The clinical and pathological data were retrospectively analyzed.The major study terminal was progression-free survival(PFS)and the minor one was overall survival(OS).Results The average age of the study group was(54.3±9.6)years,and 19(63.3%)patients received NACT.The average age of the control group was(52.3±8.3)years,and 23(76.7%)patients received NACT.There were no significant differences in the clinical features or treatments such as age,CA125 level,NACT,staging,surgical scope,residual,groups(P all>0.05).The median follow-up time of the control group was(39.0±15.3)months,which was longer than the study group(26.2±5.1)months.Within 2 years after the initial treatment,the study group had relaspse in 16(53.3%)patients,3(10.0%)patients died,while 22(73.3%)patients relapsed and 4(13.3%)patients died in the control group,there being no statistical difference.The 2-year progression-free survival(PFS)rate of the study group and the control group was 41.3%and 26.7%respectively,and there was no significant difference between the two groups(P=0.108).The 2-year overall survival(OS)rate was 89.6%and 83.3%,with no significant difference(P=0.887),either.Conclusion For patients with advanced ovarian serous carcinoma who have received the optimal cytoreduction and achieved clinical remission after initial treatment,the total number of chemotherapy cycles more than 6 isn’t associated with improved progression-free survival and further prospective clinical study is needed to prove the result.