新辅助化疗在晚期卵巢癌治疗中的意义

目的探讨新辅助化疗在治疗晚期卵巢癌中的临床意义。方法选择采用肿瘤细胞减灭术＋化疗综合治疗的Ⅲ、Ⅳ期卵巢癌患者45例,其中新辅助化疗组20例,先期手术组25例做对照研究。结果新辅助化疗组化疗有效率55.0%,腹水消失率56.3%。新辅助化疗组和先期手术组手术最佳减灭率分别为65.0%和32.0%（P〈0.05）。中位生存时间分别为34个月和28个月,两组间生存率比较,差异无统计学意义（P〉0.05）。结论对先期手术预计不能达到满意肿瘤减灭术或不能进行手术的晚期卵巢癌患者,新辅助化疗能提高最佳减灭率,但并未延长患者的生存时间。     

辅助化疗联合肿瘤细胞减灭术治疗卵巢癌的临床体会

目的 探讨新辅助化疗结合间隔肿瘤减灭术治疗晚期卵巢癌的效果.方法 对我院在2000年1月至2005年12月间收治的69例晚期卵巢癌进行回顾性分析,先行新辅助化疗,全身化疗3疗程后行间隔肿瘤减灭术,术后继续化疗6疗程,分析3年及5 年生存率.结果 明显提高肿瘤细胞减灭术的满意率,3年生存率81.1%,5年生存率55.1%.结论 新辅助化疗结合间隔减瘤术治疗晚期卵巢癌可以明显提高晚期卵巢癌患者手术满意率和生存率.     

晚期卵巢癌新辅助化疗与手术治疗的临床研究

目的探讨晚期卵巢癌新辅助化疗与手术治疗的疗效及相关影响因素。方法回顾性分析新辅助化疗结合间隔细胞减灭术（或称中间减瘤术,即给予新辅助化疗后进行的瘤细胞减灭术）治疗的52例晚期卵巢癌病例。结果根治性切除及肿瘤细胞减灭术38例（73.1%）,姑息性切除14例（26.9%）。术后并发症22例（42.3%）,围手术期死亡2例,病死率3.8%。结论手术治疗是晚期卵巢癌患者的首选治疗,新辅助化疗有助于达到满意的肿瘤细胞减灭术,对提高患者生活质量并且延长生存时间具有一定价值。     

新辅助化疗联合间歇型肿瘤细胞减灭术治疗34例晚期卵巢癌的疗效及预后分析

[背景]观察新辅助化疗(NACT)联合间歇型肿瘤细胞减灭术治疗晚期卵巢癌的疗效及预后.[病例报告]选择自2005年1月至2015年12月间的113例晚期卵巢癌患者,其中观察组34例,采用NACT联合间歇型肿瘤细胞减灭术治疗;对照组79例,先行肿瘤细胞减灭术再行辅助化疗;两组化疗方案均为紫杉醇联合卡铂.比较两组患者的手术情况、临床疗效及生存率.结果见,观察组患者行NACT后的腹水量、CA125水平及原发肿瘤的最大直径与接受NACT前比较均明显下降(P<0.05).观察组的平均手术时间、术中平均出血量、CA125水平、理想减灭率以及临床疗效均明显优于对照组(P<0.05),而两组复发情况与生存率间无明显差异(P>0.05).[讨论] NACT联合间歇型肿瘤细胞减灭术在晚期卵巢癌治疗上具有较好的效果,但在控制复发及提高生存率方面无明显优势.     

血清CA125水平动态变化对上皮性卵巢癌中间性肿瘤细胞减灭术效果的判断价值

目的:探讨血清CA125水平动态变化对上皮性卵巢癌中间性肿瘤减灭术效果的判断价值。方法:选择40例接受新辅助化疗后实施肿瘤细胞减灭术的上皮性卵巢癌患者,采用化学发光免疫分析技术定量检测治疗前、每疗程化疗后3周、手术前及手术后7~14d患者血清CA125浓度。分析CA125水平、CA125半衰期、新辅助化疗第1个疗程化疗后CA125下降率与新辅助化疗及肿瘤细胞减灭术疗效的关系。结果:新辅助化疗后肿瘤达到缓解(CR+PR)组或肿瘤细胞减灭术达到满意效果组(病灶残留<1cm)患者CA125半衰期均分别显著低于肿瘤稳定(SD)组或减灭术未达满意效果组(病灶残留≥1cm)(均为P<0.05),然而新辅助化疗后肿瘤达到缓解组或肿瘤细胞减灭术达到满意效果组患者第1个疗程化疗后血清CA125下降率显著高于肿瘤稳定(SD)组或减灭术未达满意效果组(均为P<0.05)。结论:血清CA125半衰期、第1个疗程化疗后CA125下降率有助于判断上皮性卵巢癌患者新辅助化疗和肿瘤细胞减灭术的效果。     

晚期卵巢癌的先期化疗20例临床分析

目曲探讨先期化疗在晚期卵巢癌治疗中的临床意义。方法分析我院48例曾行肿瘤细胞减灭术的晚期卵巢癌患者，其中20例行先期化疗，术前行1～3个疗程以铂类为主的化疗；28例未行先期化疗，直接手术，比较两组患者疗效及2年生存率。结果行先期化疗组20例患者，化疗总有效率达85％，胸腹水的控制率达88．2％，满意肿瘤细胞减灭术达85％，术后并发症发生率100k；术前未行化疗组满意肿瘤细胞减灭术的53．6％，术后并发症发生率42．9％，两组比较差异有显著性（P〈0．05）。结论先期化疗能控制胸腹水，缩小瘤体，增加满意肿瘤细胞减灭术的成功率，降低手术并发症的发生率。     

动脉介入化疗栓塞在晚期上皮性卵巢癌中的应用

目的:探讨动脉介入化疗栓塞在晚期上皮性卵巢癌治疗中的意义。方法:1999年12月1日至2012年5月31日在我院实施肿瘤细胞减灭术的晚期上皮性卵巢癌患者共100例,按术前是否行动脉介入化疗栓塞分为2组,即动脉介入化疗栓塞组(治疗组)和初次肿瘤细胞减灭术组(对照组)。治疗组27例,对照组73例,治疗组术前予1~2疗程动脉介入化疗栓塞后再行肿瘤细胞减灭术,对照组行初次肿瘤细胞减灭术,对其进行回顾性分析,比较2组患者临床各项指标、相关预后因素及累积生存率。结果:治疗组分级高、期别晚者所占比例高,但达到满意的肿瘤细胞减灭术者所占比例比对照组高,两者比较差异无统计学意义(P>0.05)。多因素生存分析显示手术病理分期及手术满意度是影响患者总的生存率的独立预后因素(P=0.010及P=0.011)。治疗组3年和5年累积生存率分别为64%和48%,对照组为62%和40%,差异无统计学意义(P>0.05)。结论:术前估计难以达到满意的肿瘤细胞减灭术的晚期上皮性卵巢癌患者,行动脉介入化疗栓塞可能提高手术的成功率,但不能提高患者总的生存率。     

晚期上皮性卵巢癌综合治疗效果分析

目的探讨晚期上皮性卵巢癌的有效治疗方法。方法回顾性分析154例晚期上皮性卵巢癌患者的临床资料,就手术和化疗对预后的影响进行评价。结果154例患者均接受手术治疗,其中104例达到理想的肿瘤细胞减灭术。术后有149例患者接受了化疗,其中完成初次6~8个疗程者有111例,使用化疗方案为PT和PAC。分析表明,理想的肿瘤细胞减灭术、足量的化疗与患者的预后都有着良好的相关性(P<0.01,P<0.01)。PT方案组的5年生存率显著高于PAC方案组(P<0.01),复发率显著低于PAC组。结论理想的肿瘤细胞减灭术加正规化疗是当前治疗晚期上皮性卵巢癌的有效方法。     

64例Ⅳ期上皮性卵巢癌的临床分析

目的研究Ⅳ期上皮性卵巢癌的临床病理特征及预后影响因素,为Ⅳ期上皮性卵巢癌的治疗提供参考。方法回顾性分析1997年1月至2009年12月中山大学肿瘤医院收治的经手术及病理确诊为Ⅳ期上皮性卵巢癌患者共64例的临床病例资料及随访资料,其中32例患者直接行手术治疗（PDS）,32例患者先行新辅助化疗（NACT）,再接受中间性肿瘤细胞术（IDS）。分析各临床病理因素及治疗方法对预后的影响。结果未发现年龄、治疗前CA125水平、病理类型、肿瘤分化程度、原发肿瘤大小、转移类型、是否新辅助化疗及手术满意程度等与总生存时间相关（P〉0．05）。仅因胸水细胞学阳性诊断为Ⅳ期的患者行新辅助化疗＋中间性肿瘤细胞减灭术者总生存时间中位数较直接行手术治疗者长39个月（P=0．020）。新辅助化疗与手术的满意程度相关（P〈O．001）。结论在经过评估无法行满意的肿瘤减灭术的患者,新辅助化疗＋中间性肿瘤细胞减灭术可考虑成为Ⅳ期卵巢癌治疗的选择之一。     

新辅助化疗联合肿瘤细胞减灭术中热灌注治疗晚期卵巢癌疗效观察

目的 :探讨新辅助化疗联合肿瘤细胞减少灭术中热灌注治疗晚期卵巢癌的临床疗效。方法 :针对我院从2012年4月~2013年7月收治的120例晚期卵巢癌的患者,随机分为两组,观察组患者术前采取腹腔内热灌注辅助化疗(以铂类为基础)进行处理,对照组采取常规的新辅助化疗进行处理,两组患者随后采取合肿瘤细胞减灭术进行手术,比较两组患者在手术时间、出血量、腹水量、术后的住院时间、并发症、疗效、复发与死亡、生存率等数据的差异。结果 :观察组患者在术中的各项疗效和术后的各种恢复表现均优于对照组,且具有显著的统计学差异。结论 :在临床上对于晚期卵巢癌患者采取术前的热灌注辅助化疗联合肿瘤细胞减灭术,对于患者的预后和疗效较常规的方法有较大的提高,值得在临床上进行推广。     

诱导化疗在舌鳞状细胞癌治疗中的应用及意义

目的探讨诱导化疗对舌鳞癌患者局部病灶及生存率的影响。方法 63例舌鳞癌患者随机分为2组：Ⅰ组（单纯手术）42例;Ⅱ组（诱导化疗＋手术）21例,应用SPSS10.0软件统计分析2组5年生存率。结果 （1）Ⅱ组诱导化疗总有效率为71.0%（22/31）,完全缓解2例。（2）Ⅰ、Ⅱ组的5年生存率分别为35.7%、61.3%,2组间有显著性差异（P〈0.05）;Ⅱ组诱导化疗有效者和无效者5年生存率分别为68.2%、22.2%,2组间有显著性差异（P〈0.05）;Ⅱ组中诱导化疗无效者和Ⅰ组5年生存率分别为22.2%、35.7%,2组间无显著性差异（P〉0.05）。结论有效的诱导化疗能缩小原发灶,显著提高舌鳞癌患者的生存率。     

卵巢癌术前新辅助化疗疗效及对肿瘤标志物的影响

目的 分析卵巢癌术前新辅助化疗疗效及对肿瘤标志物的影响。方法 选取2016年2月至2017年2月锦州医科大学中国人民解放军967医院妇产科收诊的卵巢癌患者87例,将其中41例在卵巢癌手术前接受新辅助化疗的患者归为观察组,接受常规的术后化疗的46例患者归为对照组,进行回顾性分析。比较两组患者治疗前后肿瘤标志物水平及治疗1、2、3年生存率变化。结果 治疗前,两组患者CEA、CA19-9、CA125、血清HE4水平比较,差异无统计学意义(P0.05)。治疗后,两组患者4项肿瘤标志物水平均低于治疗前,且观察组低于对照组,差异有统计学意义(P0.05)。观察组和对照组患者术后1年生存率分别为85.37%、84.78%,两组比较差异无统计学意义(P0.05),观察组和对照组术后2年、3年生存率分别为73.17%、56.52%和63.41%、41.30%,观察组高于对照组(P0.05)。结论 新辅助化疗能有效提升卵巢癌患者的化疗效果,改善患者血清肿瘤标志物水平,提高术后生存率,具有极高的临床推广价值。     

Neoadjuvant intraarterial chemotherapy and embolization in treatment of advanced ovarian epithelial carcinoma

Background The purpose of the study was to evaluate the role of neoadjuvant chemotherapy and embolization via the anterior branches of the bilateral internal iliac arteries in treating patients with advanced ovarian epithelial carcinoma.Methods Forty-two patients with advanced ovarian epithelial carcinoma (study group) were treated via the anterior branches of the bilateral internal iliac arteries after cytoreductive surgery and 7 courses of adjuvant platinum-based combination chemotherapy. Primary cytoreductive surgery was performed in 43 patients with advanced ovarian epithelial carcinoma (control group), and then followed by 8 courses of adjuvant platinum-based combination chemotherapy. The rate of optimal cytoreductive surgery, survival rate, blood loss during operation and operative time were investigated in the two groups. Statistical significance was asessed using Student’s t test, the Chi-squre test and the log-rank test. Results In the study group, the rate of optimum debulking after platinum-based chemotherapy and embolization via the anterior branches of the bilateral internal iliac arteries was 71.43%(30/42) (χ2=10.06, P&lt;0.005), and 9 (21.43%) of the 42 patients showed no gross residual disease after surgery. Blood loss and operative time were significantly decreased in the study group as compared with those in the control group (665.24±37.61 ml: 849.31±41.20 ml, t1=33.21, P1&lt;0.001; 4.23±0.21 hours: 6.15±0.38 hours, t2=28.92, P2&lt;0.01). In the study group,the mean survival time and the median overall survival were 33.66 months (95% CI, 24.73 to 42.58) and 26.00 months (95% CI, 19.22 to 32.78), respectively. The median disease-free interval was 18.20 months. In the control group, the mean survival time and the median overall survival were 32.38 months (95% CI, 24.92 to 39.84) and 25.00 months (95% CI, 22.80 to 27.20), respectively. The median disease-free interval was 14.20 months.The overall survival rates were not significantly different between the two groups (χ2=6.48,P&gt;0.05).Conclusions Neoadjuvant platinum-based combination chemotherapy and embolization via the anterior branches of the bilateral internal iliac arteries is an alternative treatment for patients with advanced ovarian epithelial carcinoma, in whom the chance of optimal cytoreductive surgery is low. The treatment can reduce blood loss, decrease operative time, and increase the rate of optimal cytoreductive surgery; but the median survival can’t be improved significantly.     

Primary sarcoma of the ovary: clinicopathological characteristics, prognostic factors and evaluation of therapy

Background  The primary ovarian sarcoma is a very rare malignancy. The objective of this study was to further investigate the clinicopathologic features and outcome in patients with primary sarcoma of the ovary.

Methods  Between 1988 and 2007, 24 patients with primary ovarian sarcoma who underwent treatment at Peking Union Medical Hospital were reviewed retrospectively. Response to treatment, progression and overall survival were analyzed.

Results  Patients with ovarian sarcoma had a mean age of (54.3±10.3) years, and 16 of them were postmenopausal. The most common symptom was abdominal pain, present in 14 patients. Of the 24 patients, 16 patients were pathologically diagnosed as carcinosarcoma (known as malignant mixed mesodermal tumor (MMMT)), 2 as ovarian leiomyosarcoma (LS) and 6 patients as ovarian endometrial stromal sarcoma (ESS). The patients in optimal debulking group had a median survival period of 28 months and 1-year survival rate of 71%. The patients in suboptimal debulking group had a significantly lower median survival of 6 months (P=0.02) and 1-year survival rate of 29%. Among the patients, 23 patients received chemotherapy and most of regimens were based on platinum, 3 patients received chemoradiation. The mean number of courses of combined chemotherapy was 6.6±5.0, and the response was unsatisfactory. The median survival for the entire group was 18.7 months. The one-year survival rate was 58%, and two-year survival rate only 29%.

Conclusions  Ovarian primary sarcoma has a poor overall prognosis. Optimal debulking surgery appears to be of prognostic significance. There is a clear need for further study to explore the role and the regimen of platinum-based chemotherapy in primary ovarian sarcoma.

     

晚期卵巢癌新辅助化疗研究进展

目前卵巢癌的标准治疗方案是以手术为主,辅以术后化疗,实现满意肿瘤细胞减灭术是手术的目的。但患者出现明显症状时,疾病大多已处于晚期,多数患者无法实行满意肿瘤细胞减灭术。新辅助化疗结合间隔手术作为晚期卵巢癌患者的替代治疗方案具有较好的应用前景。文章就晚期卵巢癌新辅助化疗的研究进展作一综述。     

新辅助化疗在局部晚期食管癌中的疗效分析

目的 比较分析局部晚期食管癌行新辅助化疗联合手术治疗(CS组)与单纯手术治疗(S组)5年生存率、手术切除率、术后并发症及病死率,评价新辅助化疗在局部晚期食管痛治疗中的价值.方法 收集自2003年8月至2009年3月局部晚期食管癌(cT3-4N1M0)患者117例,其中新辅助化疗联合手术治疗42例,单纯手术治疗75例.评估新辅助化疗疗效,将两种治疗方式的手术切除率、术后并发症及病死率进行比较,并回顾性分析两组患者5年生存率.结果 新辅助化疗后完全缓解率达11.9%,部分缓解率达47.6%,总有效率为59.5%.CS组手术切除率为100%,S组为89.5%,两组间差异有统计学意义(P=0.029).CS组术后病死率为0,S组为1.3%,两组间差异无统计学意义(P=0.452).两组患者术后吻合口瘘、肺部感染、声音嘶哑、乳糜胸等并发症发生率差异均无统计学意义.CS组术后第1、2、5年生存率分别为83.2%、57.4%、31.7%,S组为81.3%、49.4%、26.4%,CS组总生存率稍高于S组,但差异无统计学意义(P=0.266).进一步分层分析,化疗有效患者(CR+PR)第1、2、5年生存率分别为83.6%、71.1%、51.8%,相对于S组差异有统计学意义(P=0.010).结论 新辅助化疗可提高局部晚期食管癌患者的手术切除率及化疗有效患者的远期生存率,并且不增加术后病死率及并发症发生率.     

保乳手术联合新辅助化疗治疗乳腺癌的安全性分析

目的：探讨保乳手术联合新辅助化疗治疗乳腺癌的安全性。方法选取2005年3月～2008年3月广州市海珠区妇幼保健医院收治的乳腺癌患者148例,按照患者意愿分为观察组（n=89）和对照组（n=59）。对照组行乳腺癌改良根治术,观察组先给予以紫杉醇和（或）表阿霉素为主的联合新辅助化疗,化疗效果达到完全缓解（CR）或部分缓解（PR）,且原发病灶缩小至≤3 cm者行保乳手术,否则行乳腺癌改良根治术。对两组患者术后5年局部复发率、生存率及手术后并发症、外观效果进行比较。结果（1）观察组所有患者均完成预期的化疗周期,临床缓解率（PR＋CR）为78.7%（70/89）,成功完成保乳手术61例;（2）观察组行保乳手术患者术后并发症率显著少于对照组,差异有统计学意义（χ2=5.908,P＜0.05）,乳房外观效果优良率为78.69%（48/61）。两组术后5年局部复发率比较（χ2=3.348）及生存率比较（χ2=0.774）,差异无统计学意义。结论保乳手术并不会显著增加复发风险,而新辅助化疗为更多的患者提供了保乳条件。新辅助化疗联合保乳手术具有较高的安全性,而且提高了患者术后生活质量。     

Therapeutic strategy in the management of stage Ⅱ-Ⅳ epithelial ovarian carcinoma

Objective To investigate the optimal time of debulking in stage Ⅱ to stage Ⅳ epithelial ovarian carcinoma, considering corresponding advantages of both surgery and chemotherapy. Methods From January 1989 to December 1996, ninety-five stage Ⅱ to stage Ⅳ ovarian cancer patients were treated under two different regimens. Group A-76 cases (2 cases in Ⅱ(a)stage, 4 cases in Ⅱ(b)stage, 6 cases in Ⅱ(c)stage, 58 cases in Ⅲ(c)stage and 7 cases in Ⅳ stage) was managed according to a traditional surgery-chemotherapy regimen; and group B-19 cases (17 cases in Ⅲ(c) stage and 2 cases in Ⅳ stage) was managed with a chemotherapy-surgery-chemotherapy regimen.Results The optimal debulking rate (no macroscopic residual or residual &lt;2 cm) in group A was significantly lower than in group B, being 32.9% (25/76) and 68.4% (13/19), respectively (P&lt;0.001). The average survival time of those with a residual focus &gt;2 cm was shorter than those with a residual focus &lt;2 cm, in both groups. Sixteen out of the 51 patients with a residual focus &gt;2 cm had a second debulking operation, among whom 7 had preoperative chemotherapy. All of these 7 patients had either no residuals or residual &lt;2 !cm. In 9 cases without preoperative chemotherapy, the residuals were all &gt;2 cm. The average survival time among these two groups were significantly different (P&lt;0.01). Conclusion (1) For those patients in whom optimal debulking was clinically assessed to be possible, timely operation is mandatory. (2) For those inoperable advanced cases, chemo-therapy-surgery-chemotherapy regimen is recommended. (3) For those with residuals &gt;2 cm and were assessed to be difficult to eradicate during second-look operation, multi-route chemotherapy (intro-arterial, intraperitoneal, and systematic) should be given before going on the second debulking operation. Positive attitude and proper regimen would offer better results. (4) A multicenter prospective study would give more decisive conclusion.