卵巢上皮癌淋巴结转移化疗的临床疗效分析

Clinical Efficacy Analysis of Chemotherapy to LymphNode Metastasis in Epithelial Ovarian Cancer

背景与目的:卵巢上皮癌属化疗中度敏感肿瘤,随着肿瘤细胞减灭术及铂类联合化疗的应用,其疗效有明显改善,但其淋巴结转移病灶对化疗的敏感性尚存异议。本研究通过回顾性分析临床资料,以评价卵巢上皮癌患者淋巴结转移对化疗的敏感性及其预后。方法:对1986年6月～2001年2月收治的50例卵巢上皮癌淋巴结转移患者进行回顾性分析,其中Ⅲ～Ⅳ期32例,治疗后复发18例。50例均有可评价疗效的淋巴结转移灶,其中38例有可评价的盆腔、腹腔肿瘤。46例接受术前化疗1～3疗程、肿瘤细胞减灭术、术后化疗。化疗疗效评价按实体瘤疗效评价标准。化疗包括术前、术后或复发患者的化疗,其中45例接受含铂类联合化疗,包括CP(环磷酰胺+顺铂)、CAP(环磷酰胺+顺铂+阿霉素或表阿霉素)、TC(紫杉醇+卡铂)、TP(紫杉醇+顺铂)、吉西他滨+卡铂及IEP(顺铂+异环磷酰胺+足叶乙甙)方案,1例用美法仑,1例用CF(环磷酰胺和5-氟尿嘧啶)方案,3例用IFO+VP-16(异环磷酰胺+足叶乙甙)。结果:全组淋巴结转移灶和肿瘤的有效率分别为68.0%、71.1%。Ⅲ～Ⅳ期初治患者淋巴结转移和盆腹腔肿瘤有效率分别为78.1%、76.7%;而复发组两者有效率均为50.0%。结论:卵巢上皮癌的淋巴结转移,无论Ⅲ～Ⅳ期还是复发患者,其对化疗敏感性与盆腹腔肿瘤相近。

BACKGROUND ＆OBJECTIVE: Epithelial ovarian cancer is moderate sensitivity to chemotherapy; the survival has been improved by aggressive cytoreductive surgery followed by combination chemotherapy with cisplatin based regimen.However,there is a controversy about chemotherapeutic sensitivity of its lymph node metastasis. This study was designed to evaluate chemotherapeutic sensitivity and prognosis of lymph node metastases in epithelial ovarian cancer. METHODS: The authors retrospectively analyzed 50 cases of epithelial ovarian cancer with lymph node metastases in Cancer Hospital,Chinese Academy of Medical Sciences, Peking Union Medical College from June 1986 to February 2001, which included 32 cases with stage Ⅲ Ⅳ, and 18 with recurrent disease. All the 50 patients were with valuable metastatic lymph nodes,and among these patients 38 were also with valuable abdominal pelvic tumor. Forty six patients received 1 3 courses of neoadjuvant chemotherapy,cytoreductive surgery, and postoperative chemotherapy. The response rate was evaluated by the response criteria for solid tumor. The chemotherapy included neoadjuvant chemotherapy, and chemotherapy for patients with residual tumor after operation or recurrence. Forty five patients received platinum based chemotherapy regimens [including CP (cyclophosphamide＋cisplatin), CAP (cyclophosphamide＋epirubicin＋cisplatin), TC (paclitaxel＋carboplatin), TP (paclitaxel＋cisplatin),cisplatin＋mitomycin＋vincristine＋etoposide＋carboplatin,gemcitabine＋carboplatin，IEP(ifosphamide＋etoposide＋cisplatin regimens) and 1 patient received melphalan,1 patient with CF(cyclophosphamide＋5 fluorouracil)regimen,3 patients with ifosphamide＋etoposide.RESULTS:The overall response rates of lymph node metastasis and abdominal pelvic tumor were 68 0％〓and 71 1％, respectively (P >0 05). The response rates of lymph node metastasis and abdominal pelvic tumor for stage Ⅲ Ⅳ〓were 78 1％〓and 76 7％, respectively (P >0 05); both were 50％〓for recurrent patients with epithelial ovarian cancer. CONCLUSION: Either in stage Ⅲ Ⅳor in recurrent patients with epithelial ovarian cancer, chemotherapeutic sensitivity of lymph node metastasis was similar to that of abdominal and pelvic tumor. The prognosis was related to the optimality of cytoreductive surgery, and the intensity of chemotherapy.