新辅助化疗不同疗程数对晚期上皮性卵巢癌患者近远期疗效的影响分析

Analysis of the impact of different courses of neoadjuvant chemotherapy on the short-term and long-term efficacy of patients with advanced epithelial ovarian tumor

目的:研究新辅助化疗(NACT)不同疗程数对晚期上皮性卵巢癌的近期以及远期疗效的影响。方法:回顾性分析2015年1月至2018年12月在我科接受NACT联合间歇性肿瘤细胞减灭术(NACT-IDS)治疗的晚期上皮性卵巢癌的患者42例,按NACT疗程数分为4组,2周期为G1组,3周期为G2组,4周期为G3组,≥5周期为G4组。观察各组患者近期疗效指标以及远期疗效,其中近期疗效指标包括NACT前后血清肿瘤标记CA125水平变化情况,无肉眼可见残留病灶(R0)比率、病理缓解情况;远期疗效指标包括中位无进展生存期(PFS)、总生存期(OS)情况。结果:前3组(G1、G2、G3)NACT后肿瘤标记CA125水平下降>90%,各组间比较差异无统计学意义(P>0.05);G4组肿瘤标记下降<80%,与前3组比较,差异有统计学意义(P<0.05)。G4组的R0比率以及病理缓解率均较前3组明显下降(P<0.05);前3组间比较,差异无统计学意义(P>0.05)。G4组患者的PFS及OS均较前3组缩短(P<0.05);前3组的PFS、OS比较,差异无统计学意义(P>0.05)。结论:通过分析不同NACT疗程数对晚期上皮性卵巢癌患者近期以及远期疗效的影响,有助于指导临床选择合适的手术时机,改善患者预后,避免过多NACT疗程给患者预后带来负面影响。

Objective:To study the impact of different courses of neoadjuvant chemotherapy(NACT)on the short-term and long-term efficacy of advanced epithelial ovarian tumor.Methods:A retrospective analysis was conducted of 42 patients with advanced epithelial ovarian tumor who received NACT followed by intermittent tumor ablation(NACT-IDS)in our department from January 2015 to December 2018.According to the number of courses of NACT,they were divided into 4 groups:G1 group for 2 cycles,G2 group for 3 cycles,G3 group for 4 cycles,and G4 group for≥5 cycles.The short-term and long-term therapeutic effects of patients in each group were observed.The short-term efficacy included changes of serum tumor marker CA125 levels before and after NACT,ratio of R0 without gross residual tumor,and pathological remission;long term efficacy indicators include progression-free survival(PFS)and overall survival(OS).Results:After NACT,the level of tumor marker CA125 in former three groups(G1,G2,G3)decreased by more than 90%,and there was no significant difference among these groups(P>0.05);The tumor markers in G4 group decreased by<80%,which was statistically different from the former three groups(P<0.05).The R0 ratio and pathological remission rate in G4 group were significantly lower than those in the former three groups(P<0.05);There was no significant difference among the former three groups(P>0.05).PFS and OS in G4 group were lower than those in the former three groups(P<0.05);There was no significant statistical difference between PFS and OS in the former three groups(P>0.05).Conclusion:By analyzing the impact of different NACT courses on the short-term and long-term outcomes of patients with advanced epithelial ovarian tumor,it is helpful to guide the clinical selection of appropriate surgical opportunities,improve the prognosis of patients,and avoid the negative impact of excessive neoadjuvant chemotherapy courses on the prognosis of patients.