Comparative analysis of ATP-based tumor chemosensitivity assay-directed chemotherapy versus physician-decided chemotherapy in platinum-resistant recurrent ovarian cancer

Objective The aim of the study was to evaluate the role of ATP-based tumor chemosensitivity assay(ATP-TCA) in patients with platinum-resistant recurrent ovarian cancer(PRROC).Methods A total of 43 patients with PRROC who underwent chemotherapy based on the results of ATPTCA in the Cancer Hospital,Chinese Academy of Medical Sciences were included in the present study.As controls,we selected another 43 patients with PRROC who were treated at the physician's discretion within the same time period and had the same clinical characteristics as the patients in the ATP-TCA group.Logrank test and Cox proportional hazards model were adopted for analysis.Results A total of 86 patients were retrospectively analyzed in the present study.Patients were routinely monitored to evaluate the rate of progression-free survival(PFS).The median follow-up time was 13 months.The PFS for the ATP-TCA and control groups was 5 and 3 months,respectively(P = 0.027).Multivariate analysis showed that the type of treatment was an independent prognostic factor for PFS(P = 0.040;HR:0.623;95% CI:0.313–0.973).Subgroup analysis showed that among patients with a treatmentfree interval(TFI) of ≥ 3 months(n = 50),those in the ATP-TCA group had longer PFS than those in the control group(7 vs 4 months,P = 0.010).Meanwhile,the median PFS of patients who underwent ≤ 2 prior chemotherapy regimens(PCR,n = 52) in the ATP-TCA and control groups was 6 months and 4 months,respectively(P = 0.025).Conclusion ATP-TCA-directed chemotherapy might improve the PFS in PRROC.In particular,the survival benefit from ATP-TCA is higher in patients with a TFI of ≥ 3 months or treated with ≤ 2 PCR.

TREATMENT OPTIONS FOR PATIENTS WITH RECURRENT OVARIAN CANCER:A REVIEW OF 54 CASES

Objective To evaluate the efficacy of treatment options for patients with recurrent ovarian cancer.Methods From 1990 to 2000, 54 patients with recurrent ovarian cancer primarily treated in Peking Union Medical College Hospital were selected and reviewed.All the clinical data related to the recurrent tumor were collected.Two-side P values for differences in survival were calculated by the Cox regression model.Results The platinum-free interval >6 months and the surgery followed by salvage chemotherapy prolonged survival time of the patients with recurrent ovarian cancer (95% CI=0.153-0.987, P=0.047; 95% CI=1.611-10.914, P=0.003, respectively).The increased number of chemotherapy cycles (> 10 months) offered some benefit on the survival (95% CI=0.110-1.090, P=0.070).The initiation of treatment and chemotherapy regiments failed to demonstrate an improvement in survival.Conclusion The treatment options for patients with recurrent ovarian cancer depend on the platinum-free-interval of the patients.A strategy of secondary surgical cytoreduction followed by salvage chemotherapy is suggested for the patients with platinum-sensitive disease.

Application value of ATP based bioluminescence tumor chemo-sensitivity assay in the chemotherapy for ascites caused by recurrent ovarian cancer

Objective: To investigate the clinical value and application of ATP based bioluminescence tumor chemo-sensitivity assay (ATP-TCA) in the chemotherapy for ascites caused by recurrent ovarian cancer. Methods: More than 10 kinds of chemotherapeutic drugs or combinations were applied and 35 ascites specimens from recurrent ovarian cancer were analyzed by ATP-TCA. Sensitivity of chemotherapeutic drugs was assessed. After 2-4 chemotherapeutic cycles, clinical outcomes were analyzed, which were compared with those of 40 cases by empirical regimens. Results: 32 of 35 specimens were evaluated with an overall evaluation rate of 91%. The assay results suggested that chemo-naive patients responded to chemotherapeutic drugs with individualized profiles. The sensitivity rates of GEM, EPI, OXA, DDP, CBP, ADM, VP-16, CTX, NVB, 5-FU, PTX and TXT were 40%, 30%, 33%, 29%, 33%, 38%, 25%, 33%, 38%, 33%, 25% and 20%, respectively. While the sensitivity rates of combinations GEM + EPI, GEM + CBP, GEM + DDP, NVB + DDP, CTX + ADM + DDP, CTX + ADM, DDP + VP-16, OXA + 5-FU, VP-16 + IFO, PTX + DDP, TXT + CBP, VCR + CTX + MTX, DDP + CPT-11, OXA + CPT-11, and DTIC + CTX were 47%, 50%, 36%, 44%, 30%, 33%, 27%, 33%, 40%, 27%, 23%, 14%, 28%, 30% and 17%, respectively. In vitro results correlated well with clinical outcomes. Objective response rate (RR) in chemo-sensitivity-guided group was of significance compared with that in empirical-regimen-guided group. Conclusion: ATP-TCA is a choice for the screening of chemotherapeutic drugs against ascites caused by recurrent ovarian cancer with excellent sensitivity and reliability. ATP-TCA assay results correlate well with clinical outcomes, suggesting its clinical value in the management of difficult-to-manage therapeutic situations such as ascites in recurrent ovarian cancer.

Recurrent epithelial ovarian cancer and hormone therapy

The role of hormone therapy in the treatment of ovarian cancer is not clear. Data on the efficacy and safety of antiestrogens and aromatase inhibitors in recurrent ovarian cancer have been accumulated through phase Ⅱ clinical studies. Most of these studies were conducted in platinum-resistant recurrent ovarian cancer, and although complete response rates were not high, reported adverse events were low. If administered to patients who are positive for estrogen receptors, hormone therapy may become a viable option for the treatment of recurrent ovarian cancer.

Pegylated Liposomal Doxorubicin as a Single Agent or as Combination Therapy with Carboplatin in Patients with Recurrent or Refractory Epithelial Ovarian Cancer

OBJECTIVE Pegylated liposomal doxorubicin （PLD; CAELYX ）, a novel formulation of doxorubicin with enhanced therapeutic efficacy and reduced toxicity, has demonstrated improved progression-free survival in recurrent or refractory ovarian cancer. The objective of this open-label, noncomparative, observational study was to determine the efficacy and safety of PLD monotherapy or combination therapy with carboplatin for patients with cancer. recurrent or refractory ovarian METHODS Sixty-two patients with recurrent or refractory ovarian cancer who completed a platinum-based chemotherapy regimen and demonstrated platinum sensitivity for first-line treatment at least 6 months prior to study entry were enrolled in 20 centers in China. PLD was given as monotherapy （50 mg/m2 infused over 60 minutes） or as combination therapy （30 mg/m2 1-hour infusion） with carboplatin （area under the curve 5 mg.min/mL 1-hour infusion） on day 1 every 28 days for 4 cycles. The primary endpoint was objective response （OR） rate or CA-125 level. Secondary endpoints included time to response, time-to-progression, health-related quality of life, and safety. RESULTS Overall, 48% of the 62 evaluable patients achieved a confirmed OR. More patients receiving PLD and carboplatin achieved an OR vs the PLD monotherapy group （63% vs. 37%）. The median time to response and disease progression was 58.5 days and 56.0 days, respectively. Overall and drug-related adverse events were reported for 39% and 34%, respectively. The most commonly reported adverse events were stomatitis （22.6%） and palmar-plantar erythroderma （9.7%）. Two deaths were reported. CONCLUSION PLD is an effective and well tolerated agent in women with recurrent or refractory epithelial ovarian cancer.

Platinum-resistant ovarian cancer: Prematurely stopped phase Ⅱ Austrian AGO chemotherapy studies

AIM： To report the results of two phase Ⅱ studies of chemotherapy in patients with platinum-resistant and platinum-refractory ovarian cancer and discuss the cur-rent status of systemic therapy in this disease.METHODS： Two subsequent Austrian Arbeitsgemein-schaft für Gynkologische Onkologie （AGO） phase Ⅱ studies have been carried out. Patients either had platinum-refractory or platinum-resistant disease, i.e., disease progression during first line platinum-based therapy or recurrence within 6 mo following the last platinum-containing chemotherapy, respectively. In the first study, 6 cycles of irinotecan at 55 mg/m2 and docetaxel 25 mg/m2 were both administered on days 1, 8 and 15 of a 4 wk cycle. In the second phase Ⅱ study, either non-pegylated （PEG） liposomal doxorubi-cin （L-DXR） 60 mg/m2 monotherapy on day 1 and PEG filgrastim on day 2 （arm A） or L-DXR at 50 mg/m2 and gemcitabine （GEM） at 650 mg/m2 on day 1 and GEM on day 8 （arm B） were administered every 4 wk. Patients in arm B received prophylactic filgrastim 5 μg/kg per day from days 3 to 6 and from days 9 to 12, respec-tively. RESULTS： Response rates in studies were 14% and 17%, respectively. The progression-free survival was less than 3 mo. Diarrhea was most prevalent in patients treated with irinotecan ＋ docetaxel, while stomatitis/mucositis occurred in a quarter of patients treated with L-DXR ＋/- GEM ＋ granulocyte colony stimulating factor, respectively. Following treatment with the latter regi-men, a total of 11 serious adverse events were record-ed among the 12 patients included. The rate of remis-sions of the regimens used in these two Austrian AGOstudies was low and their toxicity significant. Due to their low therapeutic index, neither of these regimens can be recommended in this heavily pretreated patient population with platinum-resistant ovarian cancer ex-hibiting a high tumor-associated symptom burden. CONCLUSION： The two reported phase Ⅱ studies of the Austrian AGO in platinum-resistant disease had to be terminated prematurely due to a low therapeutic index. Treatment of this disease remains a clinical di-lemma. Bevacizumab seems to be active at this late-stage disease but may be associated with significant bowel toxicity.

Effects of DC-CIK cell immunotherapy combined with chemotherapy on immune function, coagulation function and tumor stem cell markers in patients with recurrent ovarian cancer

Objective: To investigate the effects of immunotherapy with dendritic cells (DC)-cytokine induced killer cells (CIK) combined with chemotherapy on immune function, coagulation function and tumor stem cell markers in patients with recurrent ovarian cancer. Methods: A total of 80 cases in our hospital for treatment of recurrent ovarian cancer patients were selected as the research object, they were divided into chemotherapy group (n=35) and combined treatment group (n=45) according to whether or not to receive cellular immunotherapy, chemotherapy group received TC chemotherapy, combined therapy group were given DC-CIK cell immunotherapy combined with TC chemotherapy group, the two groups were treated with 21 d for a cycle, 3 cycles were treated;The changes of immune function, coagulation function and tumor stem cell markers were compared between the day of blood collection and the end of treatment for 7 d. Results: After the end of treatment for 7 d, the CD3+, CD3+CD4+, CD4+/CD8+, NK cell number of combined treatment group were significantly higher than that of blood collection day, the number of CD4+ CD25+ was significantly lower than that of blood collection day, The improvement of peripheral blood T lymphocyte subsets in the combined treatment group was better than that in the chemotherapy group;After the end of treatment for 7 d, the FIB levels of two groups were significantly decreased than those of the blood collection day, the difference was statistically significant;After the end of treatment for 7 d, the CD133 and DDX4 levels of two groups were significantly lower than that of the blood collection day, and the combined treatment group was significantly lower than the chemotherapy group, the difference were statistically significant. Results: DC-CIK cell immunotherapy combined with chemotherapy can significantly improve the immunity and the level of FIB of patients with recurrent ovarian cancer, and regulating the level of serum tumor stem cell markers in patients, it has positive significance to improve the prognosis of patients, and is worthy of popularization and application in clinic.

Expression and clinicopathologic significance of RASSF1A and WT1 in recurrent epithelial ovarian cancer

Objective To explore the expression and clinicopathological significance of RASSF1A and WT1 in recurrent epithelial ovarian cancer.Methods Sixty-three cases of patients with pathologically confirmed epithelial ovarian cancer were collected in the department of Gynaecology and Obsterics of the North China University of Technology from January 2013 to December 2018.The expression of RASSF1A and WT1 were measured by IHC staining.The relation of these proteins with ovarian cancer was also analyzed.Results Compared with non-recurrent group(46.4%),the positive expression rate of RASSF1A was 17.1%in recurrent group.The positive expression rate of WT1 was 74.3%and higher than the rate of 42.8%in non-recurrent group.The reducing expression of RASSF1A was related to clinical stage,differentiation,and with ascites(P<0.05).The increasing expression of WT1 was related to pathological type,clinical stage,histological differentiation,with ascites,and lymph node metastasis(P<0.05).Conclusion Low expression of RASSF1A and high expression of WT1 may be related to recurrent epithelial ovarian cancer.

Postrecurrence Clinical Outcome of Patients with Stage I Epithelial Ovarian Cancer Who Underwent Fertility-Sparing Surgery Compared to Those with Radical Surgery

Background: To examine the difference in the survival of patients with recurrent ovarian cancer who received fertility-sparing surgery (FSS) and those receiving radical surgery. Methods: Clinicopathologic data on a total of 90 patients with stage I recurrent ovarian cancer collected under the central pathological review system were subjected to survival analyses. Patients were divided into 2 groups: 1) FSS (N = 11), 2) Radical (N = 79). Results: Five-year overall survival rates of patients in the two groups were as follows: 40.8% (FSS)/44.2% (Radical), respectively. There was no significant difference in overall survival among the groups (P = 0.887). Additionally, three-year postrecurrence survival rates of patients in the two groups were 24.8% (FSS) and 25.3% (Radical) (P = 0.730). Furthermore, we accumulated 137 patients {FSS (N = 58), Radical group (N = 79)} with stage I recurrent ovarian cancer from the current study and six representative reports in the literature. Patients who experienced recurrence in the remaining ovary alone (FSS) showed a more favorable prognosis than those who had extra-ovarian site recurrence (overall survival: P = 0.021, postrecurrence survival: P = 0.069). Conclusions: Although our retrospective analysis was very preliminary, we could propose the hypothesis that patients with stage I recurrent ovarian cancer who undergo FSS may not show poorer survival rates than patients who receive radical surgery.

Ovarian cancer stem cells: Can targeted therapy lead to improved progression-free survival?

Despite significant effort and research funds, epithelial ovarian cancer remains a very deadly disease. There are no effective screening methods that discover early stage disease; the majority of patients are diagnosed with advanced disease. Treatment modalities consist primarily of radical debulking surgery followed by taxane and platinum-based chemotherapy. Newer therapies including limited targeted agents and intraperitoneal delivery of chemotherapeutic drugs have improved disease-free intervals, but failed to yield longlasting cures in most patients. Chemotherapeutic resistance, particularly in the recurrent setting, plagues the disease. Targeting the pathways and mechanisms behind the development of chemoresistance in ovarian cancer could lead to significant improvement in patient outcomes. In many malignancies, including blood and other solid tumors, there is a subgroup of tumor cells, separate from the bulk population, called cancer stem cells(CSCs). These CSCs are thought to be the cause of metastasis, recurrence and resistance. However, todate, ovarian CSCs have been difficult to identify, isolate, and target. It is felt by many investigators that finding a putative ovarian CSC and a chemotherapeutic agent to target it could be the key to a cure for this deadly disease. This review will focus on recent advances in this arena and discuss some of the controversies surrounding the concept.

Oxaliplatin-based combination chemotherapy is still effective for the treatment of recurrent and platinum-resistant epithelial ovarian cancer： results from a single center

Background Combination paclitaxel and carboplatin is currently a first-line regimen for ovarian cancer.However,many patients develop tumor recurrence or drug resistance to this regimen.The study aims to investigate the effectiveness and safety of an oxaliplatin ＋ epirubicin ＋ ifosfamide regimen for the treatment of recurrent and drug-resistant epithelial ovarian cancer.Methods A retrospective analysis of 73 patients with recurrent and drug-resistant ovarian cancer was performed; 38 cases of them received oxaliplatin ＋ epirubicin ＋ ifosfamide regimens （lAP group）,35 patients received non-oxaliplatinbased chemotherapy regimens （control group）.The therapeutic effects and side effects of the oxaliplatin ＋ epirubicin ＋ ifosfamide regimen were analyzed and summarized.Kaplan-Meier survival curves and Cox proportional hazards regression were used to compare progression-free and overall survival between the two groups.Results Of the 38 patients in the lAP group,14 patients （36.84％） achieved complete remission,12 （31.58％） achieved partial remission,2 （5.26％） achieved stable disease and 10 （26.32％） developed progressive disease.The overall effective rate （complete or partial remission） of the lAP regime was 68.42％.While,of the 35 patients in the control group,12 patients （34.29％） achieved complete remission,3 （8.57％） achieved partial remission,5 （14.29％） achieved stable disease and 15 （42.86％） developed progressive disease.The overall effective rate was 42.86％,which was lower than that in the lAP group （P=0.035,X2=4.836）.Progression-free survival was 9.5 months （0-64 months） in the lAP group vs.3 months （0-74 months） in the non-oxaliplatin group （P=0.014 by Kaplan-Meier survival curves; HR=-2.260; 95％C/1.117-4.573; P=0.023 by Cox proportional hazards regression）.Median overall survival was 46 months （9-124 months）in the lAP group vs.35 months （9-108 months） in non-oxaliplatin group （P=0.018 by Kaplan-Meier survival curves;HR=2.272; 95％CI 1.123-4.598; P=0.022 by Cox proportional hazards regression）.In lAP group,15.79％ （6/38）of the patients suffered grade Ⅲ-Ⅳ bone marrow arrest.The main non-hematological side effects of the lAP regimen included nausea and vomiting （21.05％,8/38）,peripheral neurotoxicity （15.79％,6/38） and hepatic or renal lesions （2.63％,1/38）.The main side effects of the two chemotherapy regimens showed no statistical difference.Conclusion The oxaliplatin-based lAP regimen is potentially effective for salvage chemotherapy in patients with recurrent and drug-resistant ovarian cancer,with a better therapeutic effect and tolerable side effects.

RESULTS OF SECOND-LOOK LAPAROTOMY WITH EXTENSIVE DISSECTION OF RETROPERITONEAL LYMPH NODE IN OVARIAN CANCER PATIENTS

Objective: To evaluate retrospectively the results of extensive lymphadenectomy during second-look laparotomy on patients with ovarian cancer. Methods: A total of 63 patients with ovarian malignancies received second-look laparotomy (SLL). Retroperitoneal lymph nodes, including pelvic and para-aortic lymph nodes below the level of left renal vein, were extensively dissected. Results: Of the 63 patients, residual tumor was found in 24 (38.0%) on SLL. The frequency of residual tumor was positively correlated with the clinical stage and with the amount of tumor left after initial debulking but not with degree of differentiation of tumor cells. Lymph node metastasis(LNM) was pathologically confirmed in 19 cases (30.2%), of which no residual tumor was found in 8 patients. Tumor recurred in only 4 of the 39 patients (10.3%) with negative SLL. The overall 3- and 5-year survival rate were 75.0% and 68.0%, respectively. Conclusion: Extensive retroperitoneal lymph node dissection was recommended during SLL. It favored a decrease in recurrence rate in ovarian cancer patients negative on SLL.

Pegylated liposomal doxorubicin/carboplatin combination in ovarian cancer, progressing on single-agent pegylated liposomal doxorubicin

AIM: To assess the efficacy and safety of the combination of pegylated liposomal doxorubicin(PLD) and carboplatin in patients with recurrent epithelial ovarian carcinoma(ROC), following disease progression on single agent PLD. METHODS: An analysis of the medical records of 10 patients with ROC, treated in our institution with a combination of PLD and carboplatin following progression on single-agent PLD therapy was performed. The median age was 59.1 years(range, 45 to 77 years). All diagnoses were histological-proven. Eight of the 10 patients were platinum-resistant. Following disease progression on single-agent PLD treatment, carboplatin area under the curve(AUC)-5 was added to PLD in all 10 patients. In order to assess disease status, Ca-125 was assessed before each PLD/carboplatin treatment. Relative changes in Ca-125 values were calculated, and response defined as a greater than 50% reduction in Ca-125 from baseline. Radiographic studies were reevaluated and responses to therapy based on com-puter tomography(CT) scans carried out on a regular basis every 2-3 mo in each patient. Statistical analysis was performed using SPSS(V19).RESULTS: A median of 10 cycles(range, 2-26) of the carboplatin-PLD combination was given. Of the 10 treated patients, 6 had > 50% reduction in Ca-125 levels from baseline, 4 of these had a partial response according to Response Evaluation Criteria in Solid Tumors(RECIST) criteria, and the other 2 patients had no measurable disease. In a further 2 patients with a best response of disease stabilization and < 50% reduction of Ca-125 levels, one had progression of disease after 26 cycles, and the second progressed with brain metastases following 12 cycles. Seven of the eight patients who were platinum-resistant showed evidence of clinical benefit on carboplatin-PLD combination therapy; 5 of these had > 50% reduction in Ca-125 level, 4 also showed a partial response on CT scan. The treatment was generally well-tolerated by the patients. CONCLUSION: Addition of carboplatin to PLD, after disease progression on single-agent PLD therapy, is both effective and safe in patients with ROC, even in those with Platinum-resistant disease.

Comparison of Clinical Efficacy between Laparoscopy and Open Operation in the Treatment of Early Ovarian Cancer

The purpose of the study was to investigate the clinical efficacy of laparoscopy and laparotomy in the treatment of early ovarian cancer.The clinical data of 86 patients with early-stage ovarian cancer admitted to the department of Obstetrics and Gynecology of Zhanjiang Central People’s Hospital from January 2012 to January 2015 were retrospectively analyzed.According to different surgical methods,42 patients undergoing laparoscopic surgery were included in the observation group and 44 patients undergoing open surgery were included in the control group.Serum level of hs-CRP were measured before treatment(T0),immediately after treatment(T1)and 24 h after treatment(T2),respectively.The perioperative indicators and recurrence rates were compared between the two groups.The results showed that the serum levels of hs-CRP in the T1 and T2 observation groups were 29.6±8.4 mg/L and 32.8±10.1 mg/L,respectively,which were significantly lower than those in the control group(35.4±10.3 mg/L and 39.7±12.6 mg/L),with statistically significant differences(P<0.05).The operative time of the observation group was 252.4±26.9 min,which was significantly longer than that of the control group 201.5±32.7 min,and the difference was statistically significant(P<0.05).The intraoperative blood loss in the observation group was 16.2±31.2 mL,which was significantly less than that in the control group 215.9±43.8 mL.The number of lymph node dissection in the observation group was 35.2±1.4,which was higher than that in the control group 22.4±9.2.The postoperative exhaust time was 36.4±1.5 h in observation group,which was shorter than that in the control group 49.2±13.7 h,and the differences in all the above indicators were statistically significant(P<0.05).The incidence of postoperative complications in the observation group was 7.14%,significantly lower than that in the control group(22.73%),and the difference was statistically significant(P<0.05).After 18 months of follow-up,the postoperative recurrence rate in the observation group and the control group was 9.52%and 6.82%,respectively,with no statistically significant difference(P>0.05).Therefore,laparoscopic surgery in the treatment of early ovarian cancer can achieve the same clinical effect as open surgery,and has the advantages of mild stress response,less bleeding,and lower incidence of postoperative complications.

阿帕替尼联合多柔比星二线治疗铂类耐药的复发性卵巢癌的成本-效果分析

目的从中国卫生体系角度评价阿帕替尼联合多柔比星二线治疗铂类药物耐药的复发性卵巢癌(OC)的经济性。方法基于APPROVE试验和相关文献数据构建三状态分区生存模型,模型模拟时限为10年,循环周期为4周,成本和效果的贴现率为5%。以成本和质量调整生命年(QALYs)作为模型产出指标并计算增量成本-效果比(ICER),评价阿帕替尼联合多柔比星对比多柔比星单独化疗二线治疗铂类药物耐药的复发性OC的经济性,并采用单因素敏感性分析、概率敏感性分析以及情境分析验证基础分析结果的稳健性。结果基础分析结果表明,与单独化疗相比,阿帕替尼联合多柔比星方案的ICER为124678.25元/QALY,低于本研究设定的意愿支付(WTP)阈值(3倍我国2022年人均国内生产总值257094元)。情境分析结果显示,随着模拟时限的延长,阿帕替尼联合多柔比星方案的ICER逐渐降低,降幅逐渐减小,均低于本研究设定的WTP阈值。单因素敏感性分析结果显示,对ICER影响程度最大的因素包括疾病进展状态效用值、体表面积、贴现率和最佳支持治疗成本等。概率敏感性分析结果表明,在本研究设定的WTP阈值下,阿帕替尼联合多柔比星方案具有经济性的概率超过99%。结论从中国卫生体系角度,以3倍我国2022年人均国内生产总值为WTP阈值,阿帕替尼联合多柔比星对比多柔比星单独化疗二线治疗铂类药物耐药的复发性OC更具经济性。

复发性卵巢癌患者预后的危险因素分析

目的 分析复发性卵巢癌患者的预后以及危险因素,为卵巢癌的临床治疗及预后提供参考依据。方法回顾性选取2017年1月—2023年1月淮安市第一人民医院收治的40例复发性卵巢癌患者的临床资料,依据预后情况分为存活组(15例)和死亡组(25例),分析患者生存率、死亡率及影响预后生存的相关危险因素。结果 40例复发性卵巢癌患者,15例存活,生存率为37.50%,死亡25例,死亡率为62.50%。两组患者复发伴腹水、二次肿瘤细胞减灭术、靶向药物的使用与化疗疗程等因素比较,差异有统计学意义(P均<0.05)。复发伴腹水(OR=6.472,95%CI:3.161~13.249)与化疗疗程<6次(OR=3.288,95%CI:1.595~6.776)均为复发性卵巢癌患者影响预后生存时间的独立危险因素(P均<0.05),而二次肿瘤细胞减灭术(OR=0.297,95%CI:0.154~0.573)以及靶向药物的使用(OR=0.136,95%CI:0.097~0.630)均为影响生存时间的保护因素(P均<0.05)。结论复发性卵巢癌患者生存期较短,且预后较差,复发伴腹水与化疗疗程<6次均为影响复发性卵巢癌患者预后的独立危险因素。而二次肿瘤细胞减灭术以及靶向药物的使用均为影响患者预后生存时间的保护因素,临床应结合患者的自身状况,合理规范化的制订化疗方案,尽可能的延长患者生存期。

保留生育功能手术治疗早期上皮性卵巢癌患者的临床疗效及术后妊娠情况的影响因素

目的探讨保留生育功能手术治疗早期上皮性卵巢癌患者的临床疗效及术后妊娠情况的影响因素。方法根据手术方法的不同将104例早期上皮性卵巢癌患者分为对照组(n=53,卵巢癌根治术)和观察组(n=51,保留生育功能手术)。比较两组患者的围手术期指标、并发症发生情况及复发情况,记录观察组患者的月经恢复及妊娠情况。采用Logistic回归模型分析保留生育功能手术后早期上皮性卵巢癌患者妊娠情况的影响因素。结果观察组患者术中出血量明显少于对照组,手术时间明显长于对照组,住院时间明显短于对照组,差异均有统计学意义(P﹤0.01)。两组患者的并发症总发生率及1、2年复发率比较,差异均无统计学意义(P﹥0.05)。随访2年,观察组中27例患者尝试受孕,其中9例患者妊娠成功,纳入妊娠组;另外18例患者妊娠失败,纳入未妊娠组。单因素分析结果显示,妊娠组和未妊娠组患者的临床分期、化疗情况及复发情况比较,差异均有统计学意义(P﹤0.05)。多因素Logistic回归分析结果显示,临床分期、化疗情况及复发情况均是保留生育功能手术后早期上皮性卵巢癌患者妊娠情况的独立影响因素(P﹤0.05)。结论保留生育功能手术治疗早期上皮性卵巢癌患者安全可行,不会增加复发率,有生育意愿者可尝试受孕。对于合并术后妊娠危险因素的患者,临床需采取相应措施以提高妊娠率。

复发性卵巢癌患者术后血清CA125、D-D水平及残留病灶大小对无瘤生存期的影响

目的 探讨复发性卵巢癌患者术后血清糖链抗原125(CA125)、D-二聚体(D-D)水平及残留病灶大小对无瘤生存期的影响。方法 回顾性分析50例复发性卵巢癌患者的临床资料,随访并记录无瘤生存期。统计患者一般资料及术后血清CA125、D-D水平,分析无瘤生存期影响因素;以Pearson相关系数分析术后CA125、D-D水平及残留病灶大小与无瘤生存期的相关性。结果 不同临床分期、分化程度、化疗疗程、CA125、D-D水平及残留病灶大小的患者无瘤生存期比较,差异有统计学意义(P<0.05);COX回归分析显示,术前临床分期、术后CA125水平、术后D-D水平及术后残留病灶大小是复发性卵巢癌患者无瘤生存期的独立影响因素(P<0.05);Pearson相关性分析显示,术后CA125、D-D水平及残留病灶大小与无瘤生存期均呈负相关(P<0.05)。结论 复发性卵巢癌患者术后CA125、D-D水平及残留病灶大小是影响其无瘤生存期的重要因素。

贝伐珠单抗联合TC方案治疗晚期复发性卵巢癌患者的效果

目的探讨贝伐珠单抗联合TC(紫杉醇/卡铂)方案治疗晚期复发性卵巢癌患者的效果。方法选取2017年11月至2022年11月汉中市中心医院收治的92例复发性晚期卵巢癌患者进行随机对照试验,采用随机数字表法将其分为对照组和观察组,各46例。对照组年龄(52.34±8.45)岁,国际妇产科联盟(International Federation of Gynecology and Obstetrics,IFGO)分期Ⅲ期24例、Ⅳ期22例。观察组年龄(53.21±9.67)岁,FIGO分期Ⅲ期23例、Ⅳ期23例。对照组采用TC方案治疗,观察组在对照组基础上加用贝伐珠单抗治疗;两组均治疗6个周期,约18周。对比两组患者治疗后临床疗效、肿瘤血清标志物[糖类抗原125(carbohydrate antigen 125,CA125)、人附睾蛋白4(human epididymis protein 4,HE4)、糖类抗原199(carbohydrate antigen 199,CA199)、血管内皮生长因子(vascular endothelial growth factor,VEGF)]水平、治疗后1年生存率、生存质量[采用卡氏功能状态量表(Karnofsky Performance Status Scale,KPS)]评分和不良反应发生情况。采用t检验、χ^(2)检验。结果治疗6个周期后,观察组疾病缓解率为78.26%(36/46),高于对照组的54.35%(25/46)(χ^(2)=7.771,P=0.005);观察组CA125、HE4、CA199和VEGF水平均低于对照组(均P<0.05);观察组治疗后1年生存率为73.91%(34/46),高于对照组46.65%(21/46)(χ^(2)=7.640,P=0.006);观察组KPS评分为(72.52±8.13)分,高于对照组的(64.60±7.58)分(t=4.832,P<0.001);两组主要不良反应为骨髓抑制、消化道反应和肝肾损伤;观察组与对照组各不良反应发生率相比,差异均无统计学意义(均P>0.05)。结论贝伐珠单抗联合TC方案治疗复发性晚期卵巢癌患者临床效果较好,可提高患者1年生存率和生活质量,降低肿瘤血清标志物水平,且不良反应可控。

贝伐珠单抗辅助化疗治疗复发性卵巢癌的效果及对肿瘤标志物、炎症因子水平的影响

目的探究贝伐珠单抗辅助化疗治疗复发性卵巢癌的效果及对肿瘤标志物、炎症因子水平的影响。方法选取2018年1月至2021年12月由肿瘤科收治的98例复发性卵巢癌患者为研究对象,依据治疗方式不同将其分为对照组与试验组,各49例。对照组采用紫杉醇+卡铂(PC)治疗,试验组在此基础上应用贝伐珠单抗治疗。比较两组的治疗效果。结果试验组的疾病缓解率及疾病控制率高于对照组(P<0.05)。治疗后,试验组的血管内皮生长因子(VEGF)及巨噬细胞移动抑制因子(MIF)水平低于对照组(P<0.05)。治疗后,试验组的糖类抗原125(CA125)、癌胚抗原(CEA)、糖类抗原199(CA199)及白细胞介素-6(IL-6)水平低于对照组,干扰素-γ(IFN-γ)水平高于对照组(P<0.05)。结论贝伐珠单抗辅助化疗治疗复发性卵巢癌的效果显著,可降低患者的肿瘤血管生成指标水平,改善肿瘤标志物及炎症因子水平,值得临床推广及应用。