晚期卵巢上皮性癌新辅助化疗的临床研究
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摘要
目的:探讨新辅助化疗(NACT)在晚期卵巢上皮性癌(卵巢癌)治疗中的临床意义。方法:回顾性分析了四川省肿瘤医院1999年1月-2008年12月收治的晚期卵巢上皮性癌(FIGOⅢ、Ⅳ期)患者161例,其中73例接受新辅助化疗+手术治疗+化疗(研究组),88例行初次肿瘤细胞减灭术+化疗(传统组)。结果:研究组肿瘤的手术切除率为77.1%,传统组为56.8%,差异有统计学意义(P=0.120)。研究组术中失血量,术中输血量,术中补液量,腹水量和手术时间与传统组比较,差异均有统计学意义(P<0.05)。研究组的平均无进展生存期和总体生存期分别为22.7(7-63.5)个月和33.5(13.8-92.3)个月,传统组分别为21.7(4.3-61.2)个月和32.1(12.4-114.9)个月。两对照组的无进展生存期和总体生存期差异没有统计学意义(分别为P=0.082和P=0.293)。NACT组和PDS组的5年生存率分别为17.8%和11.4%,差异没有统计学意义(P=0.503)。结论:尽管研究组患者的无瘤生存期(PFS)与总生存率(OS)和传统的手术+化疗治疗模式组的结果比较,并没有显著差异,但研究组(NACT+手术+化疗)却能明显的提高肿瘤的手术切除率、减少术中出血量,同时并没有增加手术的并发症,表明NACT组就手术而言可以达到优于传统治疗方法。而要提高患者的PFS与OS,还有待于术后化疗,包括寻找新的化疗方案与化疗途径。因此,NACT+手术+化疗的卵巢癌的治疗模式值得进一步前瞻性的随机临床研究来明确其临床价值。
卵巢上皮性癌是死亡率最高的妇科恶性肿瘤.临床常用的治疗方案是理想的初次肿瘤细胞减灭术及术后辅以铂类+紫杉醇为基础的系统化疗。对晚期不能切除的卵巢癌,新辅助化疗能降低肿瘤负荷,提高手术切除的彻底性,是一种新的治疗策略。本文综述新辅助化疗在晚期卵巢癌治疗中的、目的、病例选择标准、术前新辅助化疗选择的评估方法、化疗方案、疗程、给药途径,疗效评价以及临床价值,,以期对临床实践提供有益的证据。
Objective : To investigate the clinical significance of neoadjuvant chemotherapy ( NACT ) on advanced epithelial ovarian cancer.
Methods : Retrospective analysis of 161 patients with advanced epithelial ovarian cancer (FIGOⅢ-Ⅳ) of Sichuan province tumor hospital from 1999.1-2008.12.were performed.Of these patients,73 cases were treated with neoadjuvant chemotherapy and interval debuking surgery and chemotherapy (research group),while other 88 cases were underwent primary cytoreductive surgery and chemotherapy (traditional group). All the cases were followed by platinum-based chemotherapy after surgery.
Results : The rate of optimal surgical resection in research group and traditional group was 77.1% and 56.8% respectively .There was a significant difference between the two groups(Table 2 , P=0.120).There was a significant difference between two groups with intraoperative blood loss ,blood transfusion ,fluid transfusion , ascites volume, time of surgery. (P<0.05)The PFS (progression-free surial) and OS (overall surial) were 22.7months ( 7-63.5months ) and 33.5months(13.8-92.3months)in research group,while the PFS and OS in traditional group were 21.7months ( 4.3-61.2months ) and 32.1months ( 12.4-114.9months )。There was no significant difference between two groups in PFS and OS. (P=0.082 and P=0.293, respectively). Five year survival rate of two gourps were 17.8% and 11.4% in research group and raditional group, respectively without significant difference. (P=0.503).
Conclusion: Although the study of PFS and OS and the traditional mode of surgery plus chemotherapy group compared with results not significantly different, but the research group (NACT and surgery and chemotherapy) was able to obviously enhance tumor resection rate, decrease blood loss, while no increase in operative complications, that NACT group than the surgery can be achieved in terms of conventional treatment. In order to improve the PFS of patients with OS, yet to be post-operative chemotherapy, including the search for new means of chemotherapy and chemotherapy. Therefore, NACT and surgery and chemotherapy for ovarian cancer is worthy of further prospective randomized clinical study to clarify its clinical value.
Objective : Epithelial ovarian cancer is the highest mortality of gynecological malignancies, commonly used in clinical treatment is the ideal first cytoreductive surgery and postoperative combined with cisplatin + paclitaxel-based systemic chemotherapy. For unresectable advanced ovarian cancer, neoadjuvant chemotherapy can reduce tumor burden and improve the thoroughness of surgery, is a new therapeutic strategy. This review of neoadjuvant chemotherapy in the treatment of advanced ovarian cancer, the purpose of case selection criteria, preoperative neoadjuvant chemotherapy choose assessment method, chemotherapy, medications, route of administration, efficacy evaluation, and clinical value, in order to provide a useful clinical practice Evidence.
卵巢上皮性癌是死亡率最高的妇科恶性肿瘤.临床常用的治疗方案是理想的初次肿瘤细胞减灭术及术后辅以铂类+紫杉醇为基础的系统化疗。对晚期不能切除的卵巢癌,新辅助化疗能降低肿瘤负荷,提高手术切除的彻底性,是一种新的治疗策略。本文综述新辅助化疗在晚期卵巢癌治疗中的、目的、病例选择标准、术前新辅助化疗选择的评估方法、化疗方案、疗程、给药途径,疗效评价以及临床价值,,以期对临床实践提供有益的证据。
Objective : To investigate the clinical significance of neoadjuvant chemotherapy ( NACT ) on advanced epithelial ovarian cancer.
Methods : Retrospective analysis of 161 patients with advanced epithelial ovarian cancer (FIGOⅢ-Ⅳ) of Sichuan province tumor hospital from 1999.1-2008.12.were performed.Of these patients,73 cases were treated with neoadjuvant chemotherapy and interval debuking surgery and chemotherapy (research group),while other 88 cases were underwent primary cytoreductive surgery and chemotherapy (traditional group). All the cases were followed by platinum-based chemotherapy after surgery.
Results : The rate of optimal surgical resection in research group and traditional group was 77.1% and 56.8% respectively .There was a significant difference between the two groups(Table 2 , P=0.120).There was a significant difference between two groups with intraoperative blood loss ,blood transfusion ,fluid transfusion , ascites volume, time of surgery. (P<0.05)The PFS (progression-free surial) and OS (overall surial) were 22.7months ( 7-63.5months ) and 33.5months(13.8-92.3months)in research group,while the PFS and OS in traditional group were 21.7months ( 4.3-61.2months ) and 32.1months ( 12.4-114.9months )。There was no significant difference between two groups in PFS and OS. (P=0.082 and P=0.293, respectively). Five year survival rate of two gourps were 17.8% and 11.4% in research group and raditional group, respectively without significant difference. (P=0.503).
Conclusion: Although the study of PFS and OS and the traditional mode of surgery plus chemotherapy group compared with results not significantly different, but the research group (NACT and surgery and chemotherapy) was able to obviously enhance tumor resection rate, decrease blood loss, while no increase in operative complications, that NACT group than the surgery can be achieved in terms of conventional treatment. In order to improve the PFS of patients with OS, yet to be post-operative chemotherapy, including the search for new means of chemotherapy and chemotherapy. Therefore, NACT and surgery and chemotherapy for ovarian cancer is worthy of further prospective randomized clinical study to clarify its clinical value.
Objective : Epithelial ovarian cancer is the highest mortality of gynecological malignancies, commonly used in clinical treatment is the ideal first cytoreductive surgery and postoperative combined with cisplatin + paclitaxel-based systemic chemotherapy. For unresectable advanced ovarian cancer, neoadjuvant chemotherapy can reduce tumor burden and improve the thoroughness of surgery, is a new therapeutic strategy. This review of neoadjuvant chemotherapy in the treatment of advanced ovarian cancer, the purpose of case selection criteria, preoperative neoadjuvant chemotherapy choose assessment method, chemotherapy, medications, route of administration, efficacy evaluation, and clinical value, in order to provide a useful clinical practice Evidence.
引文
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