铂类敏感型复发性卵巢癌不同治疗方案疗效比较研究

Comparative Study on the Efficacy of Different Treatment Schemes for Platinum-Sensitive Recurrent Ovarian Cancer

目的:通过对广西医科大学附属肿瘤医院132例铂类敏感型复发性卵巢癌(platinum-sensitive recurrent ovarian cancer, PSROC)进行回顾性病例分析,研究不同临床特征对PSROC患者的总生存期(overall survival, OS)的影响,探讨影响PSROC患者生存情况的因素以及不同治疗方案对PSROC患者的预后影响,从而优化复发型卵巢癌的治疗。方法:收集2010年7月至2018年8月广西医科大学附属肿瘤医院现有电子病历数据132例PSROC患者的临床资料,包括患者复发年龄、FIGO分期、组织病理类型、无铂治疗间期(platinum-free intervals, PFI)、复发时CA125值、复发病灶、腹水这7个因素,探讨PSROC患者生存情况的影响因素并构建预后预测模型。结果:单因素分析表明:PFI、复发时CA125值、复发病灶、腹水与PSROC患者OS相关(P<0.05);复发年龄、FIGO分期、组织病理类型与OS无关(P>0.05)。COX多因素分析表明,PFI、复发时CA125值和复发病灶是PSROC患者预后的独立危险因素(P<0.05)。预后预测模型列线图可用于预测PSROC患者不同时间生存概率。本组PSROC患者随访时间2至108个月,中位随访时间33.5个月。终点分析显示:(1)中位OS在二次肿瘤细胞减灭术(secondary cytoreductive surgery, SCS)组和单纯化疗组分别为51.0个月vs 29.0个月(HR=0.45,95%CI:0.27~0.77,P=0.003),SCS组中位OS延长了22个月,差异有统计学意义(P<0.05);(2)中位OS在肿瘤残余病灶<1 cm组和肿瘤残留病灶≥1 cm组分别为55.0 vs 36.0个月(HR=0.40,95%CI:0.18~0.89,P=0.024),肿瘤残余病灶<1 cm组中位OS延长了19个月,差异有统计学意义(P<0.05);(3)中位OS在以铂类为基础的二次新辅助化疗(secondary neoadjuvant chemotherapy, SNACT)+SCS组和直接行SCS组分别为38.0个月vs 56.0个月(HR=2.02,95%CI:0.95~4.29,P=0.066),两组间差异无统计学意义;(4)中位OS在含顺铂/卡铂为主的方案(常规化疗组)化疗与其他铂类为主方案化疗疗效分别为49.0个月vs 30.5个月(HR=0.62,95%CI:0.41~0.95,P=0.029),常规化疗组中位OS延长了18.5个月,差异有统计学意义(P<0.05);(5)中位OS在含顺铂/卡铂+血管抑制剂组和含顺铂/卡铂组分别为35.0个月vs 49.0个月(HR=1.52, 95%CI:0.65~3.57,P=0.332),非靶向治疗组中位OS延长了14个月,差异无统计学意义(P>0.05);(6)中位OS在疗程<4疗程组、4~6疗程组、疗程>6疗程组分别为29.5个月vs 42.0个月vs 38.0个月(HR=0.74,95%CI:0.41~1.34,P=0.053),3组间差异无统计学意义(P>0.05)。结论:对于PSROC患者,满意的SCS给患者带来显著生存获益。对于不能直接行SCS患者,SNACT未尝不是一种可选择的治疗方式。含顺铂或卡铂的联合化疗仍是PSROC患者的首选治疗方案。

Objective:Through retrospective case analysis of 132 platinum-sensitive recurrent ovarian cancer(PSROC)cases in the Cancer Hospital Affiliated to Guangxi Medical University,this study aimed to investigate the effects of different clinical characteristics on the overall survival(OS)of PSROC patients,explore the factors affecting the survival of PSROC patients and the impact of different treatment options on the prognosis of PSROC patients,so as to optimize the treatment of recurrent ovarian cancer.Methods:The clinical data,including relapse age,FIGO stage,histopathological type,platinum-free intervals(PFI),CA125 at recurrence,recurrent lesions and ascites,of 132 PSROC patients with electronic medical re-cords from the Cancer Hospital Affiliated to Guangxi Medical University from July 2010 to August 2018 were collected to ex-plore the factors affecting the survival of PSROC patients and construct a prognostic prediction model.Results:Univariate a-nalysis showed that PFI,CA125 at recurrence,recurrent lesions and ascites were correlated to OS in PSROC patients(P<0.05);relapse age,FIGO stage and histopathological type were not correlated to OS(P>0.05).COX multivariate analysis showed that PFI,CA125 at recurrence and recurrent lesions are independent risk factors for the prognosis of PSROC patients(P<0.05).The nomogram of the prognosis prediction model can be used to predict the survival probability of PSROC pa-tients at different times.The follow-up time of PSROC patients in this study ranged from 2 to 108 months,with a median fol-low-up time of 33.5 months.The median OS were 51.0 and 29.0 months in the secondary cytoreductive surgery(SCS)group and chemotherapy alone group(HR=0.45,95%CI:0.27~0.77,P=0.003);the median OS in the former was 22 months longer than that in the latter,and the difference was statistically significant(P<0.05).The median OS were 55.0 and 36.0 months in the residual tumor lesion<1 cm group and the residual tumor lesion≥1 cm group(HR=0.40,95%CI:0.18~0.89,P=0.024);the median OS in the former was 19 months longer than that in the latter,and the difference was statistically significant(P<0.05).The median OS were 38.0 and 56.0 months in the secondary neoadjuvant chemother-apy(SNACT)+SCS group and the direct SCS group(HR=2.02,95%CI:0.95~4.29,P=0.066);and there were similar OS in the two groups.The median OS in cisplatin/carboplatin-based chemotherapy group and other platinum-based chemo-therapy group were 49.0 and 30.5 months,respectively(HR=0.62,95%CI:0.41~0.95,P=0.029);the median OS in the former was 18.5 months longer than that in the latter,and the difference was statistically significant(P<0.05).The me-dian OS were 35.0 and 49.0 months in the cisplatin/carboplatin+vascular inhibitor group and the cisplatin/carboplatin group,respectively(HR=1.52,95%CI:0.65~3.57,P=0.332);the median OS in the latter was 14 months longer than that in the former,and the difference was not statistically significant(P>0.05).The median OS were 29.5,42.0 and 38.0 months in the treatment course<4 group,the 4~6 treatment course group and the treatment course>6 group,respectively(HR=0.74,95%CI:0.41~1.34,P=0.053);and there was no statistically significant difference among the three groups(P>0.05).Conclusion:For PSROC patients,a satisfactory second operation brings significant survival benefits to the pa-tients.For patients who cannot directly undergo a second operation,SNACT may be an alternative treatment.Combination chemotherapy containing cisplatin or carboplatin is still the first choice for PSROC patients.