卵巢上皮性癌、输卵管癌和原发性腹膜癌序贯化疗的疗效分析

Analysis of sequential chemotherapy efficacy in ovarian epithelial carcinoma,fallopian tube carcinoma and primary peritoneal carcinoma

目的探讨卵巢上皮性癌(卵巢癌)、输卵管癌和原发性腹膜癌序贯化疗的疗效。方法回顾性分析1992年1月—2019年1月北京大学人民医院收治的行分期手术或肿瘤细胞减灭术且术后给予辅助化疗的100例铂敏感型卵巢癌、输卵管癌和原发性腹膜癌患者(分别为90、6、4例)的临床病理资料,根据术后辅助化疗模式不同分为序贯化疗组(70例)、常规化疗组(30例),比较两组患者的临床病理特征、化疗效果、化疗毒副反应及预后。结果(1)临床病理特征:序贯化疗组患者的年龄、肿瘤类型(包括卵巢癌、输卵管癌和原发性腹膜癌)、病理类型、国际妇产科联盟(FIGO)分期、术后残留灶大小、有无新辅助化疗、总化疗疗程数分别与常规化疗组比较,差异均无统计学意义(P均>0.05)。(2)化疗效果:序贯化疗组患者的中位完全缓解(CR)+部分缓解(PR)时间总和为80.0个月(范围:39~369个月),常规化疗组为28.0个月(范围:13~52个月),两组比较,差异有统计学意义(Z=-7.82,P<0.001)。(3)化疗毒副反应:序贯化疗组出现骨髓抑制55例(79%,55/70)、神经系统症状20例(29%,20/70),常规化疗组分别为11例(37%,11/30)、2例(7%,2/30),两组分别比较,差异均有统计学意义(P均<0.05);其余化疗毒副反应两组间分别比较,差异均无统计学意义(P均>0.05)。(4)预后:随访期内,序贯化疗组、常规化疗组患者的复发率分别为73%(51/70)、100%(30/30),中位复发间隔时间总和分别为70.5个月(范围:19~330个月)、15.0个月(范围:6~40个月),两组分别比较,差异均有统计学意义(P均<0.01)。序贯化疗组70例患者的中位无进展生存(PFS)时间为84.0个月(范围:34~373个月)、中位总生存(OS)时间为87.0个月(范围:45~377个月),常规化疗组分别为30.5个月(范围:14~60个月)、37.5个月(范围:18~67个月),两组分别比较,差异均有统计学意义(P均<0.001)。序贯化疗组患者的3年、5年、10年OS率分别为100%(70/70)、93%(65/70)、21%(15/70),常规化疗组分别为50%(15/30)、3%(1/30)和0,两组分别比较,差异均有统计学意义(P均<0.05)。结论采用序贯化疗可显著延长卵巢癌、输卵管癌和原发性腹膜癌患者的PFS和OS时间,疗效优于常规化疗患者,且毒副反应可控,建议用于卵巢癌、输卵管癌和原发性腹膜癌患者的一线化疗。

Objective To explore the sequential chemotherapy efficacy of different chemotherapeutic regimens in ovarian epithelial carcinoma,fallopian tube carcinoma,and primary peritoneal carcinoma.Methods A retrospective analysis was conducted on clinical and pathological data of 100 patients with platinum-sensitive ovarian epithelial carcinoma,fallopian tube carcinoma,and primary peritoneal carcinoma treated at Peking University Peopel′s Hospital from January 1992 to January 2019.All patients underwent staging surgery or cytoreductive surgery followed by adjuvant chemotherapy.Based on different postoperative adjuvant chemotherapy regimens,patients were divided into the sequential chemotherapy group(70 cases)and the conventional chemotherapy group(30 cases).Clinical and pathological characteristics,chemotherapy efficacy,adverse reactions,and prognosis were compared between the two groups.Results(1)Clinical and pathological characteristics:the age,tumor types(including ovarian epithelial carcinoma,fallopian tube carcinoma,and primary peritoneal carcinoma),pathological types,International Federation of Gynecology and Obstetrics(FIGO)stage,postoperative residual disease size,presence of neoadjuvant chemotherapy,and total number of chemotherapy cycles were compared between the sequential chemotherapy group and the conventional chemotherapy group.There were no statistically significant differences observed in these characteristics between the two groups(all P>0.05).(2)Chemotherapy efficacy:the median sum of complete response(CR)+partial response(PR)duration in the sequential chemotherapy group was 80.0 months(range:39 to 369 months),whereas in the conventional chemotherapy group,it was 28.0 months(range:13 to 52 months).A statistically significant difference was observed between the two groups(Z=-7.82,P<0.001).(3)Chemotherapy adverse reactions:in the sequential chemotherapy group,55 cases(79%,55/70)experienced bone marrow suppression and 20 cases(29%,20/70)had neurological symptoms.In the conventional chemotherapy group,these adverse reactions occurred in 11 cases(37%,11/30)and 2 cases(7%,2/30),respectively.Statistically significant differences were observed between the two groups for both bone marrow suppression and neurological symptoms(all P<0.05).For the other chemotherapy adverse reactions compared between the two groups,no statistically significant differences were observed(all P>0.05).(4)Prognosis:during the follow-up period,the recurrence rate in the sequential chemotherapy group was 73%(51/70)and in the conventional chemotherapy group was 100%(30/30).The median sum of recurrence-free interval was 70.5 months(range:19 to 330 months)in the sequential chemotherapy group and 15.0 months(range:6 to 40 months)in the conventional chemotherapy group.Statistically significant differences were observed between the two groups for both recurrence rate and median recurrence-free interval(all P<0.01).In the sequential chemotherapy group,the median progression-free survival(PFS)time was 84.0 months(range:34 to 373 months),and the median overall survival(OS)time was 87.0 months(range:45 to 377 months).In contrast,in the conventional chemotherapy group,the median PFS time was 30.5 months(range:14 to 60 months),and the median OS time was 37.5 months(range:18 to 67 months).Statistically significant differences were observed between the two groups for both PFS and OS(all P<0.001).In the sequential chemotherapy group,the 3-year,5-year,and 10-year OS rates were 100%(70/70),93%(65/70),and 21%(15/70),respectively.In contrast,in the conventional chemotherapy group,the OS rates were 50%(15/30)at 3 years,3%(1/30)at 5 years,and 0 at 10 years,respectively.The two groups were compared respectively,and the differences were statistically significant(all P<0.05).Conclusions Sequential chemotherapy significantly prolongs PFS and OS in patients with ovarian epithelial carcinoma,fallopian tube carcinoma,and primary peritoneal carcinoma.The efficacy is superior to that of the conventional chemotherapy,with manageable adverse reactions.The use of sequential chemotherapy as first-line treatment for patients with ovarian epithelial carcinoma,fallopian tube carcinoma,and primary peritoneal carcinoma is recommended.