靶向治疗在卵巢癌治疗方面的应用

卵巢癌是女性生殖系统常见的肿瘤之一,其发病率仅次于子宫颈癌和子宫体癌而居第三位。其中因卵巢癌致死者,却占妇科肿瘤首位,对妇女生命造成了严重威胁。目前卵巢癌仍以手术治疗为主,并辅以化疗、放疗、中药等综合治疗。尽管就卵巢癌的治疗进行了大量研究,但其5年生存率仍未得到明显提高,其中治疗后复发是一个重要的原因,50%-80%的患者将出现复发。因此,探讨卵巢癌有效的治疗方法迫在眉睫。

mir204对复发性卵巢癌患者耐药的影响及群体治疗策略探索

目的探究mir204对复发性卵巢癌患者的治疗效果。方法选取医疗机构的240例复发性卵巢癌患者为研究对象,以卵巢癌复发并耐药的患者为耐药组,以复发非耐药、未患癌的患者为非耐药组,各120例。采用病例对照研究方法,收集首次复发入院卵巢癌患者的基线信息,并分析两组患者的基因表达差异、治疗方案和治疗效果。结果两组职业、吸烟、饮酒、是否绝闭经、使用激素替代治疗与是否一级亲属患癌等方面比较,差异有统计学意义(P<0.05)。耐药组有102例mir 204表达升高,非耐药组有7例mir204表达升高,两组比较差异有统计学意义(P<0.05)。通过聚类分析和RT-PCR发现mir204和PIK3CA、PIK3R1、PTEN、AKT的表达有关联。非耐药组治疗效果优于耐药组,mir204的表达高低进行分组分析,发现mir204高表达的治疗效果相较mir204低表达更差(P<0.05)。结论mir204在复发性卵巢癌患者的治疗方案和治疗效果上有差异,可能与mir204通过PI3K-AKT信号通路的调控作用有关。

多西他赛与奥沙利铂联合治疗复发性上皮性卵巢癌疗效评价

目的观察和评估多西他赛联合奥沙利铂方案治疗复发性上皮性卵巢癌的临床疗效及安全性。方法对病理证实为复发性上皮性卵巢癌患者36例进行化疗。给药方案为:多西他赛75mg/m2,静脉滴注1h,第1天;奥沙利铂100mg/m2,静脉滴注2h,第1天。每21d重复,至少治疗2个周期。结果接受治疗的36例患者均可评价疗效,完全缓解率为8.3%,部分缓解率为47.2%,总有效率55.6%。主要毒副反应为骨髓抑制和周围神经炎。结论多西他赛联合奥沙利铂化疗方案治疗复发性上皮性卵巢癌有较好的疗效,毒副反应轻,耐受性好,值得进一步临床研究推广。

外泌体与卵巢癌耐药及治疗的关系研究进展

卵巢癌是女性妇科恶性肿瘤死亡的主要原因,多数患者由于缺乏早期症状、体征和敏感的肿瘤生物标记物而被诊断为晚期。尽管给予肿瘤减灭术和以铂为基础的化疗,但多数患者由于化疗耐药导致预后差,病死率高。近年来,外泌体作为肿瘤微环境中细胞间通讯和信息交流的介质在肿瘤发病机制中的作用备受关注,它富含核酸、蛋白质和脂质等生物活性物质,参与细胞增殖、血管生成、免疫调节、耐药及转移前生态位的形成。已有多项研究表明,外泌体参与卵巢癌获得性耐药的调控,深入了解外泌体调控卵巢癌耐药的机制,可能为外泌体在卵巢癌靶向治疗中的临床应用提供新思路。本文就外泌体与卵巢癌微环境的相互作用、外泌体参与卵巢癌耐药的机制和外泌体在卵巢癌耐药治疗中的应用价值进行综述。

姜黄素在卵巢癌治疗中的作用机制研究进展

卵巢癌是妇科三大恶性肿瘤之一,也是死亡率最高的妇科恶性肿瘤[1]。因为早期无特异性临床症状、缺乏高效的检测手段且疾病进展迅速,70%卵巢癌发现时已经进展为晚期。恶劣的生物学行为和癌细胞的高速生长导致手术治疗难以切除彻底,寻找有效的治疗药物成为亟待解决的问题。

卵巢癌综合治疗的进展与现状

卵巢上皮癌是妇科恶性肿瘤中最致命的恶性肿瘤。诊断时75％的病人已有盆腹腔广泛转移。这些病人的治疗需要适当的应用综合治疗方法。近年来卵巢上皮癌的治疗方法不断进展。本文复习近年来主要的与治疗和进展有关的文献,包括全身和腹腔化疗、新辅助化疗、间隔减瘤术,复发卵巢癌的化疗和二次减瘤术的作用等,特别强调卵巢上皮癌处理过程中化疗和手术的相互依赖作用。

腹膜后淋巴结清扫在卵巢上皮癌治疗中的价值

目的探讨卵巢上皮癌腹膜后淋巴结清扫的临床价值。方法对289例卵巢上皮癌患者进行回顾性研究。Log-ranktest进行差异性检验,Cox风险比例模型进行预后多因素回归分析。结果早期卵巢上皮癌行腹膜后淋巴结清扫并不能提高生存率(P>0.05);晚期卵巢上皮癌行腹膜后淋巴结清扫能提高患者的生存率(P<0.05);卵巢上皮癌腹膜后淋巴结清扫组中残余灶<2cm的生存率高于残余灶≥2cm的患者(P<0.05)。多因素分析显示:临床期别、残余灶、腹膜后淋巴清扫和化疗疗程是卵巢癌上皮癌的独立预后因素。结论虽然腹膜后淋巴结清扫可以改善卵巢癌患者生存率,但是建议有选择的进行。对残余灶≥2cm的卵巢上皮癌患者,行腹膜后淋巴结清扫是没有意义的。

心理干预护理联合饮食护理对卵巢癌患者治疗依从性的作用

探讨心理干预联合饮食在卵巢癌临床治疗护理中应用的价值。方法:选择在我院妇科就诊的卵巢癌病例100例,随机分为接受常规护理的对照组(n=50)和进行心理干预联合饮食护理的研究组(n=50),分析比较两组护理效果。结果:护理干预后,研究组的治疗依从性为86.00%(43/50)低于对照组的治疗依从性66.00%(33/50), p<0.05,差异有统计学意义;护理干预后,研究组患者焦虑、抑郁情绪评分低于对照组,p<0.05,差异有统计学意义。结论:心理干预联合饮食护理增加了患者的治疗依从性,缓解了患者的焦虑抑郁情绪,是治疗的临床效果得到提高,所以心理干预联合饮食护理在卵巢癌治疗护理中有较好的应用价值。

白蛋白结合型紫杉醇联合贝伐单抗在二线治疗失败晚期卵巢癌患者中的应用效果

目的探讨白蛋白结合型紫杉醇联合贝伐单抗在二线治疗失败晚期卵巢癌患者中的应用效果。方法选取2020年1月至2021年4月联勤保障部队第九〇八医院收治的136例二线治疗失败晚期卵巢癌患者作为研究对象,按照计算机随机数法分为对照组(68例)与观察组(68例)。对照组采用经白蛋白结合型紫杉醇治疗方法,观察组采用经白蛋白结合型紫杉醇联合贝伐单抗治疗方法。比较两组的治疗效果,血清癌胚抗原(CEA)、血清糖链抗原125(CA125)水平和不良反应发生情况。结果观察组的治疗总有效率高于对照组,差异有统计学意义(P<0.05)。治疗后,观察组的CEA、CA125水平均低于对照组,差异有统计学意义(P<0.05)。两组患者的不良反应总发生率比较,差异无统计学意义(P>0.05)。结论对于二线治疗失败晚期卵巢癌患者,对其实施经白蛋白结合型紫杉醇联合贝伐单抗治疗方式具有较佳效果,可有效改善患者的CEA、CA125水平,具有较高的安全性,可结合临床实际需求展开合理推广使用。

人性化护理在卵巢癌患者中的应用价值分析

目的:观察人性化护理措施对卵巢癌患者治疗过程中的积极效果。方法:选取我院妇瘤科晚期卵巢癌患者120例,随机分成观察组和对照组,各60例,两组患者文化程度、年龄、体重、肿瘤分期均无明显差别(P>0.05),具有可比性。对照组给予常规护理,观察组在常规护理的基础上,严格按照人性化护理要求进行护理。观察两组患者住院时间、住院费用、治疗满意度、患者生存质量及治疗中不良反应发生率。结果:观察组患者住院时间和住院费用明显低于对照组,差异有统计学意义(P<0.05);观察组患者治疗满意程度和生存质量明显高于对照组,且治疗不良反应发生率显著降低,差异有统计学意义(P<0.05)。结论:人性化护理措施在卵巢癌治疗过程中,可以显著降低不良反应发生率,提高患者生存质量,在卵巢癌的治疗过程中有积极作用。

卵巢上皮癌辅助化疗的研究现状

卵巢癌是女性恶性肿瘤较常见疾病,卵巢癌早期症状、体征隐匿,早期检测不健全,预后不理想[1]。全世界每年约有20 万人被确诊为本病,病死率66.67%[2]。术后残瘤大小是影响晚期卵巢癌患者预后的关键因素[3]。为提高肿瘤细胞减灭术成功率,术中除切除子宫、附件外,还要清扫盆腹腔周围相关淋巴结及转移灶,手术损伤大,并发症高。

An integrated approach utilizing proteomics and bioinformatics to detect ovarian cancer

Objective: To find new potential biomarkers and establish the patterns for the detection of ovarian cancer. Methods: Sixty one serum samples including 32 ovarian cancer patients and 29 healthy people were detected by surface-enhanced laser desorption/ionization mass spectrometry (SELDI-MS). The protein fingerprint data were analyzed by bioinformatics tools. Ten folds cross-validation support vector machine (SVM) was used to establish the diagnostic pattern. Results: Five potential bio- markers were found (2085 Da, 5881 Da, 7564 Da, 9422 Da, 6044 Da), combined with which the diagnostic pattern separated the ovarian cancer from the healthy samples with a sensitivity of 96.7%, a specificity of 96.7% and a positive predictive value of 96.7%. Conclusions: The combination of SELDI with bioinformatics tools could find new biomarkers and establish patterns with high sensitivity and specificity for the detection of ovarian cancer.

SEVEN CASES OF EPITHELIAL OVARIAN CARCINOMA WITH BRAIN METASTASIS

Objective To summarize the clinical characteristics, treatment, and prognosis of brain metastasis in patients with epithelial ovarian carcinoma. Metbods Retrospective analysis was conducted in 7 cases of brain metastases of epithelial ovarian carcinoma from January 1986 to March 2007 in Peking Union Medical College Hospital for summarizing therapy results and prognosisaffecting factors. Results Incidence of brain metastases of epithelial ovarian carcinoma was about 0. 66% （7/1 055 ）. Serous adenocarcinoma was the predominant pathological type in 4 cases and the subsequent was adenocarcinoma in 3 cases. All the patients were diagnosed at late stage, 6 cases with the International Federation of Gynecology and Obstetrics （HGO） stage Ⅲc and 1 with FIGO stage IV. The mean duration from diagnosis of ovarian carcinoma to brain metastasis was 32.7 ± 20. 0 months （range, 23-73 months）. Single metastasis focus occurred in 43% of cases and multiple metastases in 57% of cases. Fifty-seven percent of patients presented extracranial metastasis. Serum CA125 played a role in monitoring reoccur- rence and brain metastases. The average survival time was about 12 months. Better treatment with prolonged survival could be achieved by combination of operation and chemotherapy or combination of radiotherapy with chemotherapy. Concltusions As a rare condition, brain metastasis of epithelial ovarian carcinoma is rising in incidence with improved treatment of ovarian carcinoma and prolonged survival. However, brain metastasis indicates bad prognosis which can be improved by combined therapy.

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.

Comprehensive management of epithelial ovarian cancer with peritoneal metastases

Ovarian cancer has as its predominant pattern of dissemination metastases to the peritoneal surfaces and disease spread within the abdomen and pelvis that most commonly causes the patients demise. To combat peritoneal metastases, cytoreductive surgery with peritoneal and visceral resections is combined with intraperitoneal and systemic chemotherapy. Chemotherapy given in the operating room after the complete visible removal of ovarian cancer is hyperthermic intraperitoneal chemotherapy. The results of the combined treatment are determined by the extent of prior surgery, the extent of disease as established by the peritoneal cancer index, and the quality of the cytoreduction as measured by the completeness of cytoreduction score. Recent clinical information on patients with recurrent ovarian cancer suggest a median overall survival of up to 60 mo. These data are greatly improved over the one year survival observed in the past.

Role of minimally invasive surgery in complex adnexal tumours and ovarian cancer

Ovarian cancer is one of the most common causes of cancerrelated death in women. Adnexal masses are frequently diagnosed during reproductive age and often require surgical removal. The risk of malignancy when dealing with a complex adnexal mass should be defned prior to surgery and several scoring systems may be useful for this purpose. Laparoscopic management of ovarian tumours allows a minimally invasive approach with respect to several oncological assumptions. In the last decade concerns have been raised regarding the risk of cyst rupture and tumour spillage as a con-sequence of the laparoscopic technique itself both in early and advanced stages of ovarian cancer. Although limited data have been reported in the literature on the use of minimally invasive techniques in ovarian cancer, the clear benefits of this approach must be balanced with the potential hazards in different clinical situations. Laparoscopic staging in borderline tumours and presumed early-stage ovarian cancer performed by a laparoscopic oncologist seems to be safe and effec-tive when compared to laparotomy. The precise role of laparoscopy in patients with more advanced cancer is still to be defned, and the risk of suboptimal surgery should never outweigh the potential benefits of mini-mally invasive surgery. Thus, a tailored prediction of optimal laparoscopic debulking is mandatory in these patients.

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.

Metronomic chemotherapy as a palliative treatment in poor performance status patients with advanced epithelial ovarian carcinoma

Objective：The aim of our study was to evaluate the clinical efficacy and tolerability of metronomic chemotherapy in patients with advanced ovarian carcinoma.Methods：Fifteen patients with advanced ovarian carcinoma and bad performance status were subjected to daily cyclophosphamide（CTX） after failure of 1st line chemotherapy which included paclitaxel and carboplatin.Evaluation of the cases during treatment as regard treatment side effects and progression free survival.Results：Patients could tolerate low dose oral cyclophosphamide treatment without considerable side effects with improvement of performance status.The mean progression free survival was 12 months.Conclusion：Low dose oral cyclophosphamide could be considered as a palliative treatment of pretreated ovarian carcinomas with poor performance status.