疾病不确定感对卵巢上皮癌患者癌因性疲乏及化疗不良反应指标评分影响

目的分析疾病不确定感对卵巢上皮癌患者癌因性疲乏和化疗毒性不良反应指标评分的影响。方法连续选择59例卵巢上皮癌近期接受化疗（PAC方案）患者，她们分别接受了“Missals疾病不确定感量表”、癌因性疲乏评估量表和WHO制定的“抗癌药急性和亚急性毒性不良反应问卷”评估。结果癌因性疲乏指标比较中，不确定感高分组（28例）的“您是否需要休息”、“您是否感到过劳累”、“您是否已经累了”等条目得分以及癌因性疲乏总分均明显高于低分组（31例，P均〈0．01－0．05）。化疗毒性不良反应指标比较中，高分组的恶心和呕吐、腹痛、便秘、腹泻相关症状评分和毒性不良反应总分均明显大于低分组（P均〈0．01－0．05）。结论疾病不确定感评分可明确影响到卵巢上皮癌患者癌因性疲乏和化疗毒性不良反应指标评分。

Prognosis in epithelial ovarian cancer: Clinical analysis of 287 pelvic and para-aortic lymphadenectomy

Objective: To evaluate the relationship between the pelvic and para-aortic lymphadenectomy and the prognosis of epithelial ovarian cancer. Methods: 287 patients suffering from primary epithelial ovarian cancer from 1995 to 2005 were analyzed retrospectively. Results: The 3-, 5-, 10-year survival with systematic lymphadenectomy (SL) were slightly higher than those without SL, but there were no statistically significance (P > 0.05). The 3-, 5-, 10-year survival of clinical stages without SL were lower than those with SL, but there were no significant difference either (P > 0.05). The 3-,5-, and 10-year survival rates with SL were higher than those without SL with no statistically differences (P > 0.05) among the subgroups such as absent, ≤ 2 cm and > 2 cm residual tumor. The survival rates of the groups without residual tumor and the group with ≤ 2 cm residual tumor were significantly higher than that of > 2 cm (P < 0.005). On multivariate analysis, patient staging (P = 0.01) and size of residual disease after primary cytoreductive surgery (P < 0.001 and = 0.002, respectively) retained prognostic significance. SL was not proved to be an independent prognostic factor (P = 0.69). Conclusion: Systematic pelvic and para-aortic lymphadenectomy can not improve and prolong the survival time significantly.

Combination of docetaxel-carboplatin for adjuvant chemotherapy of epithelial ovarian,primary peritoneal and fallopian tube cancers:a meta-analysis

Objective： The aim of this study was to compare the efficacies and safeties of the combination of docetaxel- carboplatin with the combination of non docetaxel-carboplatin as first-line chemotherapy for advanced epithelial ovarian, pri- mary peritoneal or fallopian tube cancers. Methods： Relevant articles were identified from MEDLINE （1993-2010）, EMBASE （1980-2010）, MEDION, the Cochrane library, Science Citation Index Expanded databases, hand searching of reference lists from primary articles and reviews, conference abstracts and contact with experts in the field. The review included 5 relevant primary studies （1430 women）. Data was extracted for study characteristics and quality. Bivariate random-effect model meta- analysis was used to estimate diagnostic accuracy of the various index tests. A quantitative meta-analysis was carried out by two reviewers based on the inclusion criteria from all available studies. Results： The frequency of the subgroup analysis of toxicity showed that toxicity action of combination of docetaxel-carboplatin was more severe than that of non docetaxel- carboplatin group （OR = 1.33, 95% CI = 1.13-1.56, P = 0.0005）, whereas that of clinical responses was equivalent in com- parison combination of docetaxel-carboplatin with combination of paclitaxel-carboplatin or docetaxel-cisplatin （OR = 1.0, 95% CI = 0.87-1.16, P = 0.95）. There were heterogeneity （X2 = 79.36, P 〈 0.00001） and inconsistency （83.6%） in toxicity analysis among the trials, while neither heterogeneity （x2 = 3.21, P = 0.99） nor inconsistency （F = 0%） in clinical responses among the trials. Conclusion： The safety of combination of docetaxel-carboplatin is less than that of combination of paclitaxel- carboplatin or docetaxel-cisplatin. However, the clinical responses of combination of docetaxel-carboplatin are comparable with combination of paclitaxel-carboplatin or docetaxel-cisplatin.

Pharmacology of cancer chemotherapy drugs for hyperthermic intraperitoneal peroperative chemotherapy in epithelial ovarian cancer

The peritoneal parietal and visceral surfaces of the abdomen and pelvis are an important anatomic site for the dissemination of epithelial ovarian cancer(EOC). The transcoelomic spread of cancer cells gives rise to peritoneal carcinomatosis(PC) which, without special treatments, is a fatal manifestation of EOC. In order to control PC cytoreductive surgery to remove macroscopic disease is combined with perioperative intraperitoneal(IP) and perioperative intravenous chemotherapy to eradicate microscopic residual disease. Chemotherapy agents are selected to be administered by the IP or intravenous route based on their pharmacologic properties. A peritoneal-plasma barrier which retards the clearance of high molecular weight chemotherapy from the peritoneal cavity results in a large exposure of small cancer nodules on abdominal and pelvic surfaces. Tissue penetration is facilitated by moderate hyperthermia(41-42 ℃) of the IP chemotherapy solution. Timing of the chemotherapy as a planned part of the surgical procedure to maximize expo-sure of all peritoneal surfaces is crucial to success.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in epithelial ovarian cancer: State of the art

Advanced stage epithelial ovarian cancer(EOC) is diffi cult to treat with low overall cure rates. A new strategy combining maximal cytoreductive surgery(CRS) with intraoperative hyperthermic intraperitoneal chemotherapy(HIPEC) has been proposed to treat advanced stage EOC in the primary setting. Numerous small, heterogeneous studies have been conducted exploring outcomes in patients with predominantly advanced, recurrent or refractory disease treated with CRS + HIPEC. Although morbidity rates approaching 35% have been reported, oncologic outcomes are promising. Incorporation of HIPEC for the treatment of primary EOC has continued to gain interest. Several prospective phase 2 clinical trials were recently completed evaluating the impact of CRS + HIPEC in the primary setting. This article will briefl y discuss the benefi ts of optimal surgical cytoreduction and the theoretical basis of intraperitoneal chemotherapy in patients with advanced stage EOC, and will then review existing literature describing oncologic outcomes in EOC patients treated with HIPEC in the primary setting.

Cytoreductive surgery in primary advanced epithelial ovarian cancer

Epithelial ovarian cancer is one of the most common malignancy and one of the principal causes of death among gynaecological neoplasm. The majority of patients(about 70%) present with an advanced International Federation of Gynaecology and Obstetrics stage disease. The current standard treatment for these patients consists of complete cytoreduction and combined systemic chemotherapy(CT). An increasing proportion of patients undergoing complete cytoreduction to no gross residual disease(RD) is associated with progressively longer overall survival. As a counterpart, some authors hypothesized the improving in survival could be due more to a less diffused initial disease than to an increase in surgical cytoreduction rate. Moreover the biology of the tumor plays an important role in survival benefi t of surgery. It's still undefi ned how the intrinsic features of the tumor make intra-abdominal implants easier to remove.Adjuvant and hyperthermic intraperitoneal CT could play a decisive role in the coming years as the completeness of macroscopic disease removal increases with advances in surgical techniques and technology. The introduction of neo-adjuvant CT moreover will play a decisive role in the next years Anyway cytoreduction with no macroscopic residual of disease should always be attempted. However the defi nition of RD is not universal. A unique and defi nitive defi nition is needed.

Advanced ovarian cancer: Neoadjuvant chemotherapy plus surgery and HIPEC as up-front treatment

Epithelial ovarian cancer （EOC） is one of the most com-mon malignancies and one of the principal causes of death in gynecological neoplasms. The majority of EOC patients present with an advanced International Fed-eration of Gynecology and Obstetrics stage disease. The current standard treatment for these patients con-sists of complete cytoreduction and combined systemic chemotherapy of a platinum agent and paclitaxel. Even if the majority of patients with EOC respond to frst-line platinum based chemotherapy, almost 20% of them are resistant or refractory. According to these data, the main risk is for a certain number of patients to have undergone cytoreductive surgery （CRS） and subsequent hyperthermic intraoperative peritoneal chemotherapy （HIPEC） in a useful way. Radical surgery, especially in advanced cases, is associated with a high incidence of postoperative morbidity and mortality, which could be increased by the HIPEC. Every effort should be made for previously selected patients to improve outcome and optimize resources. Over the last decade, new options have been introduced to prolong survival. Im-proved long-term results can be achieved using CRS in combination with intraoperative HIPEC. This combina-tion has also been used in an up-front setting. Contro-versial outcomes have been reported for neoadjuvant platinum-based chemotherapy. Different papers have been published reporting discordant results. Further studies are needed.

Peritoneal carcinomatosis from advanced ovarian cancer: To treat or not to treat ethical issues suggested by a case study

This article provides a brief description of an epithelial ovarian cancer （EOC） case （stage Ⅳ） treated with the association of complete CytoReductive Surgery and hy-pertermic intraPEritoneal chemotherapy （HIPEC）. The use of HIPEC in EOC makes theoretic sense in view of the high rates of recurrence following standard treat-ment, but there are no randomized clinical trial to date and HIPEC for these patients still represents a radical treatment where the choice of no treatment may be acceptable since defnitive cure is unlikely. We reviewed the entire decision making process considering the risk/beneft of the procedure in term of mortality/morbidity, the quality of life and the psychological profile of the patient 1 year after surgery. The platform World Health Organization-International Classification of Function-ing, Disability and Health that permits evaluation of the person in relation to the psycho-social context is pre-sented. A person-centred approach and assessment of health-related quality-of-life and disability in EOC survi-vors are of central importance for decision making.

Natural history of epithelial ovarian cancer and its relation to surgical and medical treatment

Epithelial ovarian cancer(EOC) represents approximately 90% of primary malignant ovarian tumors, the sixth most common cancer in women and the second most common gynecologic cancer. Approximately 80%-85% of all ovarian carcinomas in Western society are serous and up to 95% of patients are in advanced stages(FIGO stage Ⅲ-Ⅳ) at diagnosis. Treatment of ovarian cancer is mainly based on three key approaches: surgical removal of neoplasia; chemotherapy to kill cancer cells; direct chemotherapy on peritoneal surfaces. The application of hyperthermic chemotherapy to the peritoneal cavity(HIPEC) after radical surgery may also be an attractive option. We analyzed the natural history of EOC in the literature and identified various time-points where sensitivity to chemotherapy, freedom from disease and overall survival are different. We propose eight time-points in EOC history with homogeneous oncological fi ndings. The effectiveness of HIPEC in EOC treatment should be evaluated based on these eight time-points and we believe that retrospective and prospective studies of HIPEC should be evaluated according to these time-points.

The optimal choice of chemotherapy regimens for patients with relapsed platinum-resistant epithelial ovarian cancer/primary peritoneal/fallopian tube cancer - protocol for a systematic review and network meta-analysis

Objective： Debulking surgery （residual disease of less than 1 cm） followed by platinum-taxane chemotherapy isthe current standard therapy for patients with epithelial ovarian cancer, primary peritoneal carcinoma and primaryfallopian cancer. But the prognosis remains poor. Several chemotherapy regimens could be selected for patientswith recrudescent cancer. However, the standard second chemotherapy regimen remains a subject of debate. Thepurpose of our study is to carry out a systematic review and network meta-analysis to compare the efficacy andsafety of different regimens for recurrent platinum-resistant ovarian cancer based on existing randomized controlledtrials （RCTs）. Methods and analysis： Medline, EMBASE, Cochrane Library and Cochrane Library databases,Science Citation Index Expanded, Conference Proceedings Citation Index-Science and ClinicalTrials.gov will besystematically searched for eligible studies. Randomized controlled trials （RCT） on chemotherapy, immune therapy,biological therapy, targeted therapy for recurrent platinum-resistant ovarian cancer with multiple outcome measureswill be included. The Cochrane Risk of Bias Tool will be used to assess the quality of included studies. The primaryoutcomes are overall survival and median survival time. The secondary outcomes include the safety and side effectsof these regimens. Direct meta-analysis and network meta-analysis （NMA） will be conducted to compare differentregimens. Conclusion： The results of this network meta-analysis will provide direct and indirect evidence oftreatments for recurrent platinum-resistant ovarian cancer, and it may provide a ranking of the chemotherapyregimens for patients and gynecological oncologists to help them select the best option.

Correlation between epithelial ovarian cancer and thrombocytosis

Objective： To evaluate the clinical significance of platelet （PLT） count in epithelial ovarian cancer, and to investigate the correlation between thrombocytosis and the incidence of epithelial ovarian cancer. Methods： We evaluated 220 epithelial ovarian tumor patients divided into early stage epithelial ovarian cancer group （n = 80）, advanced stage epithelial ovarian cancer group （n = 50） and benign ovarian tumor group （n = 90） as controls, who underwent primary surgical treatment. Three groups were evaluated with the relationship between platelet counts and preoperative and postoperative CA125, histopathology, abdominal edema, residual tumor, and lymph node metastasis. Epithelial ovarian cancer patients were evaluated whether platelet count was decreased after surgery. Results： The mean platelet counts were （234.55 ± 71.51）× 10^9/L in the early stage epithelial ovarian cancer group, （308.12±111.95）× 10^9/L in the advanced stage epithelial ovarian cancer group, and （206.28± 52.62） × 10^9/L in the benign ovarian tumor group, with a significant difference among the 3 groups （P 〈 0.05）. In the early stage epithelial ovarian cancer group, the platelet count was correlated with histopathology. In the advanced stage epithelial ovarian cancer group, there was a correlation between thrombocytosis and the incidence of that residual tumor diameter was greater than 2 cm. But there was no relationship between platelet count and histopathology, CA125, abdominal edema, or lymph node metastasis. In general the platelet count was decreased after surgery. Conclusion： An increased platelet count is commonly seen in patients with epithelial ovarian cancer, but it usually decreases after surgery. Patients with thrombocytosis have poor prognosis. Platelet count can be used as a marker for the development and prognosis of epithelial ovarian cancer.

Proteomic analysis of human epithelial ovarian cancer xenografts in immunodeficient mice exposed to chronic psychological stress

This work aims at comparing alterations in the proteomes of human epithelial ovarian cancer xenografts between stressed and non-stressed immunodeficient mice as well as exploring the molecular mechanisms linking chronic psychological stress to ovarian cancer oncogenesis and progression.SK-OV-3 cells were injected subcutaneously into nude mice.The stress group was subjected to a chronic physical restraint protocol for 6 h on 35 consecutive days,while the control group was unrestrained.All mice were sacrificed on day 36 after SK-OV-3 cell injection,and tumors were excised.Tumor tissues were processed for 2D gel electrophoresis,mass spectrometry(nanoUPLC-ESI-MS/MS) and Western blotting.The expression of 20 proteins was found to be significantly altered between the stress and control groups,of which 14 were up-regulated,five were down-regulated,and one protein was found only in the stress group.All proteins were identified by UPLC-ESI-MS/MS,and Western blotting results were consistent with those of proteomic methods.The present results provide new evidence relating to the molecular mechanism underlying the relationship between psychological stress and tumor progression.