晚期卵巢上皮性癌复发的影响因素及处理

目的 探讨晚期卵巢上皮性癌（AEOC）复发的影响因素及复发后的处理。方法 回顾分析了自1986年1月至1997年12月经系统首次治疗后复发的AEOC患者167例进行再次治疗的资料。采用Log-rank检验生存率差异,COX比例风险模型分析预后因素,logistic逐步回归法筛选影响缓解期的因素。结果 患者的中位年龄51岁（26－71岁）。60例行二次手术治疗,其中23例中残留癌直径≤1cm;107例进行再次化学药物治疗（化疗）。影响AEOC复发的因素有年龄,首次术后残留癌直径,一线化疗,先期化疗。二次肿瘤细胞减灭后残留癌直径≤1cm,残留癌直径＞1cm和化疗患者的中位生存时间分别为20,10,13个月（x^2=16.41,P=0.0003),经两两比较发现,残留癌直径≤1cm和化疗患者均比残留癌直径＞1cm患者预后好,并且残留癌直径≤1cm患者的中位生存时间明显长于化疗患者（x^2=3.97,P=0.0462)。二线化疗和未行二线化疗患者的中位生存时间分别为14,10个月,两者比较,差异有显著性（x^2=3.86,P=0.0494)。结论 年龄,首次术后残留癌直径,一线化疗,先期化疗等是影响AEOC复发的主要因素,二线化闻和二次肿瘤细胞减灭术是AEOC复发后有效的治疗手段。

Factors affecting disease recurrence and the role of secondary therapies in the management for patients with recurrent ovarian carcinoma

OBJECTIVE: To identify variants affecting disease recurrence and clarify the role of re-debulking surgery and second-line chemotherapy in the management of recurrent advanced epithelial ovarian cancer (AEOC). METHODS: One hundred and sixty-seven patients with recurrent AEOC treated in our hospital between Jan. 1986 and Dec. 1997 were retrospectively reviewed. Survival was calculated by Kaplan-Meier method with difference in survival estimated by Log-rank test. Independent prognostic factors were identified by the COX stepwise regression model, and variants associated with disease recurrence were found by logistic stepwise regression methods. RESULTS: The median age was 51 (range 26-71) years. Sixty patients underwent re-debulking surgery, 23 of them with residual disease 1 cm after secondary cytoreduction.