影响卵巢上皮癌化学药物治疗疗效临床病理因素的临床研究
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摘要
【目的】探讨影响卵巢上皮癌预后及化疗疗效的因素。【方法】对1985～2004年间由广西医科大学肿瘤医院收治的362例卵巢上皮癌化疗患者进行回顾性研究。用寿命表法计算生存率,用Kaplan-Meier法进行单因素分析,生存率差异性用Log-rank检验进行比较,独立的预后因素用Cox回归模型分析。【结果】1.患者1年、2年、3年、4年、5年、10年的累积生存率分别为84.99%、66.57%、57.87%、50.22%、46.09%、35.73%,中位生存期48.75个月;2.表明年龄、临床分期、病理类型、组织学分级、残余灶的大小、化疗疗程数、化疗间隔时间、紫杉醇剂量强度是影响预后及化疗疗效的因素,P<0.05,提示年轻患者较年长患者预后好;细胞分化程度高者,预后较中低分化者好;早期患者预后较晚期患者好;浆液性腺癌预后最佳,腺癌次之,粘液性腺癌第三,混合性腺癌第四;残余灶<2cm者预后较残余灶>2cm者好;化疗疗程≥6疗程者疗效较<6个疗程好,患者的生存时间随化疗疗程数增多而延长;化疗间隔≤1月者中位生存期较>1月者长;紫杉醇剂量强度175 mg/m2与135 mg/m2和136-174 mg/m2比较均有显著性,P<0.05,而化疗方案、先期化疗、化疗途径及顺铂、卡铂剂量强度等与预后无关(P>0.05);3. Cox模型对上述因素进行多因素分析显示,临床分期、术后残余灶的大小、细胞分化程度、化疗疗程数是影响预后的因素。晚期卵巢上皮癌患者死亡的相对危险度较早期卵巢上皮癌患者增加3.459倍;残余灶<2cm卵巢上皮癌患者死亡的相对危险度较残余灶>2cm卵巢上皮癌患者增加1.990倍;肿瘤细胞分化程度高者的死亡相对危险度是低分化者的68.9%;化疗疗程≥6个疗程者的死亡相对危险度是<6个疗程者的61.6%。【结论】FIGO分期、首次手术后残余灶大小、细胞分化程度、化疗疗程为卵巢上皮癌的独立预后因素。因此努力提高卵巢癌的早诊断,做到早治疗,并通过提高手术水平,初次手术时要尽量切净,使残留癌灶< 2cm,是提高卵巢上皮癌患者生存率的重要方法。术后进行正规、足量、足疗程、及时的辅助化疗也是改善生存率的必要手段。
Objective: To explore the relationship between the clinicopathological factors and the effect of chemotherapy in patients with epithelial ovarian carcinomas (EOCs). Methods: The 362 cases were analysed retrospectively for the relationship between the clinicopathological factors and the effect of chemotherapy in patients with EOCs. Results: (1).The survival rates of 1-, 2-, 3-, 4-, 5- and 10-year were 84.99%, 66.57%, 57.87%, 50.22%, 46.09% and 35.73%,respectively; the median survival time was 48.75 months. 2. Kaplan-Meier single factor analysis confirmed that the prognostic factors of EOCs were related to age(< 40 years vs. 40-60 years and > 60 years , P<0.05; clinical stage (FIGO stage I, II vs. FIGO stage III, IV, P < 0.05; pathological types(serous adenocarcinoma > adenocarcinoma > mucous adenocarcinoma > mixed adenocarcinoma, P<0.05 ; cellular grade(high differentiation vs. moderate and low differentiation, P<0.05; tumor residues(<2cm vs. >2cm, P<0.05; the cycles of chemotherapy (≥6 cycles vs. <6 cycles, P<0.05; the interval time of chemotherapy(≤1month vs. >1month, P < 0.05; and the dose-intensity of paclitaxel (175mg/m2 vs. 135 mg/m2and 136-174mg/m2, P<0.05. (2) There were no significant correlationships between prognosis and chemotherapy scheme, preoperative chemotherapy, chemotherapy methods, and the DI of cisplatin or carboplatin. 3.COX multiple factors analysis and COX proportional hazard model confirmed that the prognostic factors of EOCs were related to clinical stage, tumor residues, cellular grade,and the cycles of chemotherapy. (3) The relative risks (RRs) for mortality of patients with EOCs in FIGO stage III,IV increased 3.459 times than that of in FIGO stage I, II. The RRs for mortality of patients with more tumor residues(>2cm) increased 1.990 times than that of less tumor residues(<2cm).
Objective: To explore the relationship between the clinicopathological factors and the effect of chemotherapy in patients with epithelial ovarian carcinomas (EOCs). Methods: The 362 cases were analysed retrospectively for the relationship between the clinicopathological factors and the effect of chemotherapy in patients with EOCs. Results: (1).The survival rates of 1-, 2-, 3-, 4-, 5- and 10-year were 84.99%, 66.57%, 57.87%, 50.22%, 46.09% and 35.73%,respectively; the median survival time was 48.75 months. 2. Kaplan-Meier single factor analysis confirmed that the prognostic factors of EOCs were related to age(< 40 years vs. 40-60 years and > 60 years , P<0.05; clinical stage (FIGO stage I, II vs. FIGO stage III, IV, P < 0.05; pathological types(serous adenocarcinoma > adenocarcinoma > mucous adenocarcinoma > mixed adenocarcinoma, P<0.05 ; cellular grade(high differentiation vs. moderate and low differentiation, P<0.05; tumor residues(<2cm vs. >2cm, P<0.05; the cycles of chemotherapy (≥6 cycles vs. <6 cycles, P<0.05; the interval time of chemotherapy(≤1month vs. >1month, P < 0.05; and the dose-intensity of paclitaxel (175mg/m2 vs. 135 mg/m2and 136-174mg/m2, P<0.05. (2) There were no significant correlationships between prognosis and chemotherapy scheme, preoperative chemotherapy, chemotherapy methods, and the DI of cisplatin or carboplatin. 3.COX multiple factors analysis and COX proportional hazard model confirmed that the prognostic factors of EOCs were related to clinical stage, tumor residues, cellular grade,and the cycles of chemotherapy. (3) The relative risks (RRs) for mortality of patients with EOCs in FIGO stage III,IV increased 3.459 times than that of in FIGO stage I, II. The RRs for mortality of patients with more tumor residues(>2cm) increased 1.990 times than that of less tumor residues(<2cm).
引文
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