卵巢癌二次细胞减灭术和二线化疗疗效分析

The results of secondary cytoreductive surgery and second-line chemotherapy for patients with epithelial ovarian cancer

目的 :对铂类化疗效果不佳或缓解后复发的卵巢癌再次治疗的疗效和生存的因素分析。方法 :50例平均停用铂类药物化疗时间 (PFI)为 6 .6(0 .5～ 36)月的卵巢癌患者接受二次肿瘤细胞减灭术及术后二线化疗。结果 :二次减灭术有 33例达到满意减瘤状态 (术后残瘤≤ 1cm) ,PFI≤ 6月 1 9例。患者术后平均接受 4次 (1～ 1 1次 )的二线静脉化疗 ,其中用Taxol化疗 1 5例 ,用铂类联合化疗 35例。CR 1 8例 ,PR 2例。Logistic回归分析结果提示腹水 (P =0 .0 2 2 3)、残瘤大小 (P =0 .0 2 4 7)和化疗次数 (P =0 .0 4 97)是决定卵巢癌二线化疗效果的重要因素。行满意的再次减灭术者中位生存期达 42 .3月 ,明显高于残瘤较大患者的 1 4 .2月 (χ2 =1 3 .62 ,P =0 .0 0 0 2 )。有腹水者存活期短于无腹水者 ,两者的中位生存期分别为 1 4 .2月和 2 8.9月 (χ2 =5 .38,P =0 .0 2 0 3)。二线化疗次数大于 5次以上则生存期延长 ,中位生存期 31 .0月 ,不超过 5次的为 1 6 .5月 (χ2 =1 3 .0 5 ,P =0 .0 0 0 3)。PFI >6月者生存期达 42 .3月 ,比PFI≤ 6月者 1 7.5月长 ,但无统计学意义 (P =0 .1 4 1 8)。多因素分析结果提示PFI和化疗次数是影响卵巢癌再次治疗的独立的预后因素。对PFI≤ 6月者 ,二次手术后残余肿瘤≤ 1cm者二次手?

Purpose:To investigate the effect of secondary cytoreductive surgery and second line chemotherapy on survival of patients with epithelial ovarian cancer who failed with platinum based chemotherapy or relapsed after remission.Methods:50 patients with mean platinum free interval (PFI) of 6.6 months (0.5～36 months) received secondary cytoreductive surgery followed by second line chemotherapy.Results:33 patients achieved optimal secondary cytoreduction (the largest residual tumor ≤ 1cm),19 patients with PFI≤6 months. After secondary cytoreductive surgery , all the patients received a mean of 4 courses (1～11courses) second line chemotherapy. 15 patients received Taxol, while the others were treated with platinum based regimen. Complete response was found in 18 cases and partial response in 2. Logistic regression revealed that ascites ( P =0.0223), residual disease after secondary surgery ( P =0.0247) and courses of second line chemotherapy ( P =0.0497) were important determinants of second line chemotherapeutic outcome. There was a significance in survival between patients who were optimal cytoreduced compared to those suboptimal cytoreduced, with an estimated median survival in the optimal group of 42.3 months vs. 14.2 months in the suboptimal group (χ 2 =13.62, P =0.0002). Patients with ascites at secondary surgery had a pessimistic outcome, with an estimated median survival of 14.2 months vs. 28.9 months in those without ascites (χ 2 =5.38, P =0.0203). Those patients who received more than 5 cycles of second line chemotherapy had a better survival, with estimated median survival of 31.0 months vs. 16.5 months for patients with less cycles (χ 2 =13.05, P =0.0003). Although the median survival for patients with PFI > 6 months was 42.3 months, longer than 17.5 months for patients with PFI ≤ 6 months, no statistical significance was found ( P =0.1418). Multivariate analysis strongly suggested that PFI and the courses of second line chemotherapy were independent prognostic factors of survival after secondary treatment for epithelial ovarian cancer. For those patients with PFI ≤ 6 months, the smaller the size of residual lesion ( P =0.0003) and the more the cycle of effective second line chemotherapy ( P =0.0004), the longer the survival after the secondary cytoreduction. Conclusions:The results suggested that successful secondary cytoreductive surgery combined with multicycles second line chemotherapy may be an effective way to lengthen the survival on retreatment for patients with platinum resistant and recurrent epithelial ovarian cancer.