不同治疗方式对卵巢上皮癌患者铂类药物耐药性的影响

Platinum Resistance after Neoadjuvant Chemotherapy Interval Debulking Surgery Compared with Primary Debulking Surgery on Patients with Advanced Epithelial Ovarian Carcinoma

目的本研究回顾性分析比较初始肿瘤细胞减灭术(primary debulking surgery,PDS)辅以铂类药物的联合化疗和新辅助化疗后行间隔肿瘤细胞减灭术(neoadjuvant chemotherapy-interval debulking surgery,NACT-IDS)两种治疗方式对卵巢上皮癌患者铂类药物耐药性的影响。方法选择2007年1月至2013年12月符合研究要求的上皮性卵巢,输卵管和腹膜癌Ⅲ、Ⅳ期患者共87例,分为PDS(n=56)组和NACT-IDS(n=31)组,比较两组对铂类药物的敏感度,单因素及多因素Logistic回归分析各项基线资料与铂类药物耐药性的关系。结果以铂类药物为基础的初次治疗后,NACT-IDS组4例(7.1%)为铂耐药,PDS组也有4例(12.7%),耐药率比较两组差异有统计学意义(P<0.05)。采用多因素Logistic回归控制分析独立相关因素,NACT-IDS将增加产生铂类药物耐药的风险。手术残余病灶大小和临床分期仍是影响复发时间和铂耐药率的显著相关因素。结论晚期上皮性卵巢癌患者采取NACT-IDS治疗方式,与PDS治疗方式相比,有效化疗反应率相当,但更易出现铂类药物耐药。

Objective To retrospectively analyze the prognostic factors of platinum resistance in patients with advanced epithelial ovarian carcinoma treated with neoadjuvant chemotherapy followed by interval debulking surgery(NACT-IDS) or primary debulking surgery(PDS). Methods We divided 87 patients with stages Ⅲ and Ⅳ epithelial ovarian, tubal, and peritoneal carcinoma who underwent treatment from January, 2007 to December, 2013 into PDS(n=56) group and(n=31) NACT-IDS group, to compare the sensitivity to platinum drugs. Standard univariate analysis was performed, as was multivariable analysis with logistic regression, to analyze the relationship between baseline data and platinum resistance. Results After the initial platinum-based chemotherapy, 4(7.1%) cases in the NACT-IDS group were considered as platinum resistant disease, compared with 4(12.7%) in the PDS group(P<0.05). When univariate and multivariate logistic regression were used to control the factors independently associated with platinum resistance, NACT-IDS was significantly associated with an initial increased risk of platinum resistance. Residual lesion size and clinical staging were still the significant factors for the recurrence time and platinum resistance. Conclusion For advanced epithelial ovarian carcinoma patients treated with platinum-based chemotherapy, NACT-IDS has the similar chemotherapy efficiency to PDS, but increases the risk of platinum resistance.