摘要
目的通过回顾性分析,观察紫杉烷与铂类联合化疗(TP)对卵巢上皮性癌的临床疗效,初步探讨经TP化疗后对患者生存的影响因素。方法选择我院2004年1月至2007年10月住院治疗的卵巢上皮癌患者90例,进行回顾性研究。所有患者经卵巢癌肿瘤细胞减灭术后,初治患者给予TP一线化疗,复发患者给予TP二线化疗。采用TP方案化疗具体为:紫杉醇135mg～175mg/m2(d1)或多西紫杉醇75mg/m2(d1),顺铂60～80mg/m2或卡铂(AUC):5.0(d2)或草酸铂130mg/m2(d2)全身静脉化疗,21-28天为1疗程,至少完成4个疗程观察疗效。临床资料采用SPSS13.0统计软件处理,Kaplan-Meier法进行生存率计算,生存率差异用Log-rank检验(分层对数秩检验)进行比较,生存影响因素用Cox回归模型分析。对临床分期、病理类型、组织分化、残留病灶大小等与生存预后有关的因素进行初步探讨。结果90例EOC共完成TP化疗569个疗程,平均每个患者6.32个疗程。总有效率RR为74.44%(67/90)。(1)TP一线治疗中:早期卵巢癌组有效率为100.00%(12/12);晚期卵巢癌组有效率为77.55%(38/49),总的有效率为:81.97%(50/61)。TP二线治疗中:早期卵巢癌组有效率为80.00%(4/5),晚期卵巢癌组有效率为54.17%(13/24)。总的有效率为:58.62%(17/29)。复发患者中铂类耐药组有效率为22.22%(2/9),铂类敏感组有效率75.00%(15/20)。两组有效率差异有统计学意义(P<0.05)。(2)毒副反应:主要为Ⅱ~Ⅲ度骨髓抑制发生率62.22%(56/90),Ⅳ度骨髓抑制发生率为6.67%(6/90)。胃肠道反应发生率51.11%(46/90),周围神经炎(关节、肌肉疼痛、指趾端感觉异常等)发生率51.11%(46/90)。面色潮红发生率33.33%(30/90),轻度肝功损害约16.67%(15/90)。过敏反应发生率2.22%(2/90)。脱发100.00%(90/90)。(3)生存率为远期疗效,经Kaplan-Meier法及对数秩检验,90例患者中位生存期为20.50个月。经生存率单因素分析初治/复发、术后残留病灶大小、化疗疗效、复发患者铂类药物敏感与否、无瘤生存期(DFI)是影响生存的因素(P<0.05)。Cox模型对上述因素进行多因素分析显示:复发患者的无瘤生存期是影响生存的独立因素。结论TP方案联合化疗在卵巢上皮癌的一线化疗中疗效好,毒副反应轻,认为TP方案应作为上皮性卵巢癌的首选一线化疗方案,也可作为复发性上皮性卵巢癌铂类敏感型的二线化疗方案选择之一。术后初治EOC、残留病灶<2.0cm,TP化疗有效、复发患者中对铂类敏感、无瘤生存期≥24个月是影响生存的有利因素,其中复发者的无瘤生存期是影响生存的独立因素。
Objective Through retrospective analysis, observation taxanes combined with platinum chemotherapy(TP /PT /PC) in Epithelial Ovarian Carcinomas(EOCs) clinical curative effect, preliminary discussion after TP chemotherapy treatment the EOCs survi -val prognosis influence factors. Methods The clinical data and follow-up data of 90 epith -elial ovarian carcinomas who were treated in our hospital from January 2004 to October 2007 were retrospectively studied. The Kaplan-Meier method, log-rank test and the COX proportional hazards regression model were used to identify prognostic factors. Results TP regimenis:paclitaxel 135mg-175mg/m2 (d1) or docetaxel 75mg/m2(d1) and platinum 60-80mg/m2 (d2)or carboplatinum (AUC): 5.0 (d2) or oxaliplatin130mg/m2 (d2) iv, 21-28 day is one cycle, completed 4 cycles at least.the curative effect could be observed. (1)In induced treatment of TP:early-stage and advanced EOC had the response rate were 100.00% and77.55% ,respectively. the total RR was 81.97%(50/61). In the second treatment: It is 80.00% that the early ovarian cancer group is efficient (4/5); It is 54.17% (13/24) in the advanced ovarian cancer The total RR was 58.62%(17/29). (2) side effects of the TP therapy were tolerated .The incidence of gradeⅡorIII, IV bone marrow depression was 51.11% and6.67%, respectively. The gastro-intestinal tract response formation rate 51.11% (46/90), periphery the neuritis (joint, muscle ache, refers to foot end paraesthesia and so on) the formation rate 51.11%(46/90). The flush incidence of complexion is 33.33% (30/90), the slight liver work damages about 16.67% (15/90). allergic response about 2.22%.There is no serious chemotherapy poisonous side reaction. (3).The median survival of 90 patients with epithelial ovarian carcinoma was20.50 months. good cytoreductive surgery (no residual or residual<2.0cm) was performed to 77 patients and their survival rate was significantly higher than these of 13 unsuccessful cases (residual>2cm).prongosis could not be significantly influenced by Clinical stage, pathological types, cellular grade, postsurgerical had chemotherapy intervals .(P >0.05). first or second treatment ,size of residual, the sensitivity of platinium with ROC, and the clinical response of TP, the Disease-Free Interval(DFI) with ROC were proved to be independent prognostic factors by COX proportional hazards regression model. COX multiple factors analysis confirmed that the prognostic factors of EOCs were related to the Disease-Free Interval (DFI) with ROC. Conclusion Taxanes combined with platinium chemotherapy treated 90 EOCs showed Tp regimen had a good clinical response and less side-effects . TP chemotherapy is an effective and well tolerated regimen.It was recomm -ended as the first-line chemotherapy regimen for patients newly diagnosed stage II,III or IV postoperative EOCs,and also was suitable for the platinum-sencitived ROC.Cox proportional hazard model confirmed that the prognostic factors of EOCs were related to tumor residual after primary surgery, the sensitivity of platinium with ROC, and the clinical-response of TP, the Disease-Free Interveal(DFI) with ROC sencitive with platinum chemotherapy. And the independent prognostic factors by COX proportional hazards regression model proved was the Disease-Free Interveal(DFI) with ROC sencitive with platinum chemotherapy.
引文
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