Ⅲ期卵巢癌减灭术后腹腔残瘤对患者预后的影响

目的：分析Ⅲ期卵巢癌减灭术后腹腔残瘤对患者预后的影响因素。方法：1990年11月～1996年11月本院行初次肿瘤细胞减灭术的Ⅲ期卵巢癌57例，平均年龄51．9岁(23～74岁)。术后肉眼无残瘤9例，腹腔残瘤7例，盆腔残瘤4例，腹盆腔均有残瘤37例，残瘤≤1cm的20例。术前有30例接受化疗，术后腹腔化疗36例，平均3次，术后铂类为主静脉化疗46例，平均4次。治疗后临床完全缓解32例(56．1％)。结果：平均随访29．1月(0．3～109．1月)，Ⅲ期卵巢癌的一年、二年、三年、四年、五年生存率分别为79．82％，57．59％，49．06％，39．93％，23．41％。单因素分析发现分期(P=0．0283)、残瘤大小(P=0．0041)、腹腔残瘤(P=0．0362)、手术方式(P=0．0337)、术后腹腔化疗(P=0．0469)等因素均影响患者术后生存。多因素分析结果提示残瘤大小(P=0．0025)、术后腹腔化疗(P=0．0323)和静脉化疗(P=0．0297)是影响患者生存的独立的预后因素。术后腹腔内肉眼无残瘤者的存活率高于腹腔有残留者，中位生存期分别为58．0月和22．7月(P=0．0362)，三年、五年生存率分别为83．64％vs37．60％，29．57％vs21．05％。对于术后腹腔内肉眼有残瘤者，腹腔内残瘤小者生存期较长(P=0．0319)，盆腔内残瘤大小影响患者无瘤生存期(P=0．0104)。分期(P=0．041)、术前化疗(P=0．009)和病理类型(P=0．042)影响术后腹腔有无肿瘤残余。结论：术后腹腔残瘤和残余肿瘤大小影响Ⅲ期卵巢癌患者的生存。腹腔内有肿瘤残留者预后差，上腹部残余肿瘤影响患者生存，盆腔残余肿瘤则影响患者无瘤生存。     

晚期卵巢上皮癌的综合治疗与预后

目的：探讨晚期卵巢上皮癌的临床病理特点及综合治疗对预后的作用。方法：回顾性分析1995年1月－2001年12月该院睡治的33例经手术病理证实的Ⅲ，Ⅳ期卵巢上皮癌。结果：晚期卵巢上皮癌2年及5年生存率分别为44．18％和24．05％。5年生存率Ⅲ。期100％。Ⅲb期28．81％，Ⅲc期16．05％。Ⅳ期0；黏液性囊腺癌，透明细胞癌，混合性癌均为O，浆液性囊腺癌29．34％。内膜样癌51．68％，G1为50．42％，G242．75％，G3 2．53％。术后残留病灶＜2cm5年生存率44．18％，≥2cm5年生存率4．75％；术后化疗≥6个疗程的5年生存率47．56％，＜6个疗程的5年生存率3．89％（P＜0．01）。结论：晚期卵巢上皮癌的预后与临床分期，病理类型，组织分级，术后残留癌灶大小及化疗疗程数相关，彻底的肿瘤细胞减灭术，正确的化疗可提高疗效，延长生存期。     

巩固性腹腔内卡铂化疗对临床完全缓解卵巢癌患者治疗的价值

98例卵巢癌患者采用全身联合化疗达临床完全缓解，31例在接受3个周期的腹腔内卡铂化疗前，有25例行两次探查术，结果17例阴性，8例阳性。二探术阴性和阳性患者经化疗后2、3、4、5年生存率分别为94．1％、82．3％、64．7％、58．8％和87．5％、50．0％、37．5％、12．5％，中位生存期为68．5个月和29．5个月，无复发生存期为41个月和21个月。31例腹腔内卡铂化疗者2、3、4、5年生存率分别为90．3％、61．2％、51．6％和45．2％，中位生存期和无复发生存期分别为51．5个月和31．8个月。二探阴性和阳性患者5年生存率，中位生存期、无复发生存期间均有明显差异（P＜0．001）。67例行CAC方案（卡铂、阿霉素、环磷酰胺）联合化疗，其2、3、4、5年生存率分别为88．1％、61．2％、43．3％、32．8％，中位生存期和无复发生存期分别为39．2和18．7月。联合化疗与腹腔内化疗患者5年生存率、中位生存期和无复发生存期间有显著差异（P分别＜0．01、0．05、0．001）。表明临床评定完全缓解的卵巢癌病例宜行短期的腹腔内卡铂化疗。     

脑转移瘤放射治疗疗效及预后因素分析

目的：探讨脑转移瘤放疗疗效及预后因素。方法：从1997年6月－2000年10月对36例脑转移瘤进行放射治疗，采用6MV－X线，两侧平行相对野作全脑照射，1．8－3Gy／次，30－40Gy后缩野针对转移灶加量16－20Gy。结果：总的中位生存期为5．3个月，6个月生存率为44．4％（16／36），1年生存率为13．9％（5／36）。按RTOG脑转移瘤RPA预后分级，Ⅰ、Ⅱ和Ⅲ级中位生存期分别为10个月、5个月和2．8个月。I级中位生存期明显长于Ⅱ级（P＜0．05）和Ⅲ（P＜0．01）。结论：KPS、年龄、原发灶挖掘情况及颅外有无转移灶是脑转移患者的预后因素，RPA预后分级对脑转移瘤临床治疗有指导价值。     

青年人胃癌预后影响因素探讨：附60例报告

为了探讨青年人胃癌的治疗效果和预后影响因素，作者对1984年6月～1990年11月间收治的60例35岁以下青年人胃癌随访资料进行回顾性分析。本组占同期收治胄癌总数的7．4％，男女比例为1：1．5。56例经手术治疗，切除48例（85．7％），其中根治切除41例（73．2％），随访率100％。全组5年生存率为28．3％，根治切除组为39％，高于姑息切除和未切除组。淋巴清扫范围对早期病例5年生存率影响，统计学无显著性差异。早期与进展期间5年生存率差异P＜0．01。不规则口服化疗5年生存率低于未化疗者，P＜0．05或P＜0．01。病变部位、组织学类型、性别对生存率无影响，P＞0．05。作者认为早期诊断和根治性切除是提高生存率的关键，我们不主张不规则口服化疗。     

237例肺癌外科治疗影响预后因素的分析

目的：分析TNM分期，病理类型，年龄和手术方式与预后的关系，探讨在各影响预后因素中外科治疗手段的正确选择。方法：应用SPSS8．0统计，对237例肺癌患者资料建立数据库并进行统计分析，用寿命表法进行生存率分析。两组间生存率差异显著性检测用Logrank方法。结果：Ⅱb期以上肺癌总的5年生存率为49．8％，Ⅲa期仅为13．1％（P＜0．001），Ⅲb和Ⅳ期肺癌均为0％，但伴颅内单发转移病灶手术后平均生存期19个月。鳞癌5年生存率48．3％，腺癌和腺鳞癌分别为30．5％和13．3％（P＜0．05和＜0．01）；小细胞肺癌为0；大细胞肺癌为60．2％，70岁以下肺癌患者肺楔形切除术5年生存率为0，肺叶切除术31．4％（P＜0．01）；全肺切除术18．2％（P＜0．01）；肺叶加支气管袖状切除术37．6％（P＜0．01），70岁以上肺癌患者肺楔形切除5年生存率33．4％,肺叶切除27．0％（P＜0．05）；全肺切除和肺叶加支气管袖状切除术3年经分别为20．2％和50．5％（P＜0．01）。结论：Ⅱb期以上肺癌外科治疗应为首选；Ⅲa期应采用术前新辅助治疗的综合治疗；手术可作为Ⅲb和Ⅳ期肺癌姑息性治疗的手段；脑部单个转移病灶的肺癌不应为手术禁忌证。腺癌和腺鳞癌应以手术为主的综合性治疗；小细胞肺癌应以化疗为主的综合性治疗；透明细胞类型的大细胞肺癌以手术为主的综合性治疗。70岁以下肺癌患者肺叶切除加淋巴结清扫应为外科治疗肺癌的标准术式。70岁以下高龄肺癌患者应尽量选择对机体创伤小的术式。     

原发性肝癌的介入治疗及其预后的影响因素

目的：评价肝动脉灌注化疗栓塞(TACE)对原发性肝癌的疗效，并对影响疗效的多种因素进行分析。方法：1995年1月～2001年1月时90例肝癌患者行肝动脉介入治疗。24例单纯肝动脉灌注化疗(TAI)，66例肝动脉灌注化疗加碘油栓塞(LP-TACE)。分析其生存率与治疗方法、次数、门脉癌栓、肿瘤分型、肿瘤大小、肝功能Child分级及临床分期的关系。结果：1)全组1、2、3、4、5年生存率分别为50．O％、26．7％、16．7％、3．3％、1.1％。TACE组1、2、3、4、5年生存率分别为59．1％、31．8％、22．7％、4．5％、1．5％；TAI组1、2年生存率分别为25．0％、12．5％，无存活3年者。TACE组疗效较好，P＜O．01；2)生存期与治疗次数呈正相关，P＜O．01；3)门脉内无癌栓者的生存率显著高于门脉内有癌栓者，P＜O．05；4)单结节型生存率最高，弥漫型最差，P＜O．01；瘤径≤5cm者疗效最好，P＜O．01；5)肝功能ChildA级者疗效较好，P＜O．05；6)Ⅰ期生存率最高，Ⅲ期最差，P＜O．01。结论：肝癌介入治疗的远期疗效与治疗方法、次数、门脉癌栓、肿瘤分型、肿瘤大小、肝功能Child分级、临床分期密切相关，积极地超选择性肝动脉灌注化疗栓塞有助于提高患者的生存率。     

新辅助化疗在晚期卵巢癌治疗中的作用

目的：探讨新辅助化疗在晚期卵巢癌治疗中的临床意义。方法：分析我院63例曾行肿瘤细胞减灭术的晚期卵巢癌患者，其中24例行术前化疗，采用以铂类药物为主的化疗1～3个疗程：39例未行术前化疗，比较两组患者的疗效及5年生存率。结果：术前化疗组，手术基本切净率83.3％，术后并发症12．5％：术前未化疗组，手术基本切净率59．0％，术后并发症35．9％，两组比较差异具有显著意义（P〈0．05）。两组5年生存率分别为41．7％、43．6％．两组比较差异无显著意义（P〉0．05）。结论：新辅助化疗可提高晚期卵巢癌的基本切净率，减少术后并发症的发生率．但并未延长患者的生存期。     

CD44v6表达与胃癌临床病理因素及预后的关系

目的：研究CD44v6在胃癌组织中的表达，评估其在胃癌预后中的地位。方法：采用免疫组织化学EnVision^TM法，检测42例远隔癌灶部位“正常”胃粘膜和188例手术切除的胃癌组织中CD44v6的表达，并分析其与临床、病理特征的关系及对预后的影响。结果：CD44v6在胃癌组织中的阳性率为67．6％，明显高于远隔癌灶部位“正常”胃粘膜的表达（9.5%)（P＜0．01），并与淋巴结转移有关（P＜0．05）。Kaplan-Meier生存分析结果表明CD44v6表达与总生存率和无瘤生存率均显著相关（P＜0．01），多因素分析结果表明脉管侵犯、TNM分期和CD44v6表达是影响胃癌患者生存率的独立预后因素（P＜0．05）。结论：CD44v6在胃癌组织中具有较高的表达，有可能成为判断胃癌预后的有用指标。     

不能手术切除的直肠癌不同治疗方法研究

目的；对不能手术切除的直肠癌采用不同治疗方法的预后进行研究。方法；对52例不能手术切除的直肠癌分别采用单纯放疗，放疗＋化疗、手术＋放疗＋化疗三种方法治疗，并进行1、2、3年生存率的分析。结果：单纯放疗组18例，1、2、3年生存率分别为83．33％（15／18）、22．24％（4／18）、5．56％（1．18）；放疗＋化疗组18例，1、2、3年生存率分别为88．96％（16／18）；33．36％（6／18）；22．24％（4／18）；手术＋放疗＋化疗组16例，1、2、3年生存率分别为93．75％（15／16）；50％（8／16）；37．53％（6／16）。三组1年生存率无明显差异（P＞0．05），2、3年生存率有显著差异（P＜0．05）。结论：对不能手术切除的直肠癌，采用综合治疗是今后发展的方向，提倡先行姑息性乙状结肠造瘘术，再行综合治疗，可以提高生存率和生存质量，延长生存期。     

The role of secondary cytoreductive surgery in the treatment of patients with recurrent epithelial ovarian carcinoma

BACKGROUND: This study examined the impact of secondary cytoreductive surgery on survival of patients with recurrent epithelial ovarian carcinoma. METHODS: One hundred six patients with a disease free interval (DFI) > 6 months after primary treatment underwent secondary cytoreductive surgery. Multivariate analysis determined which variables influenced the cytoreductive outcome and survival. RESULTS: Eighty-seven patients (82.1%) underwent removal of all visible tumor. The median and estimated 5-year survival for the entire cohort after recurrence was 35.9 months and 28%, respectively. The probability of complete cytoreduction was influenced by the largest size of recurrent tumor (< 10 cm ?90.0% vs. > 10 cm ?66.7%; P = 0.003), use of salvage chemotherapy before secondary surgery (chemotherapy given ?64.3% vs. chemotherapy not given ?93.8%; P = 0.001), and preoperative Gynecologic Oncology Group performance status (0 ?100%, 1 ?91.4%, 2 ?82.4%, and 3 ?47.4%; P = 0.001). Survival was influenced by the DFI after primary treatment (6-12 months ?median, 25.0 months vs. 13-36 months ?median, 44.4 months vs. > 36 months ?median, 56.8 months; P = 0.005), the completeness of cytoreduction (visibly disease free ?median, 44.4 months vs. any residual disease ?median, 19.3 months; P = 0.007), the use of salvage chemotherapy before secondary surgery (chemotherapy given ?median, 24.9 months vs. chemotherapy not given ?median, 48.4 months; P = 0.005), and the largest size of recurrent tumor (< 10 cm ?median, 37.3 months vs. > 10 cm ?median, 35.6 months; P = 0.04). CONCLUSIONS: Complete cytoreduction is possible for the majority of patients with recurrent epithelial ovarian carcinoma and maximizes survival if undertaken before salvage chemotherapy. The authors believe a randomized trial should be initiated to confirm these findings.     

CXCL12及受体CXCR4在卵巢上皮性癌中的表达及其临床意义

目的:探讨趋化因子CXCL12及其受体CXCR4在卵巢上皮性癌组织中的表达及与临床病理特征和预后的关系。方法:采用免疫组织化学SP法检测6例正常卵巢表面上皮、44例卵巢上皮性癌原发灶和30例相应大网膜转移灶组织中的CXCL12和CXCR4蛋白表达。结果:正常卵巢表面上皮无CXCL12和CXCR4蛋白表达;卵巢上皮性癌原发灶的CXCL12和CXCR4表达阳性率分别为91%和59%。CXCL12表达强度与术中腹水量有显著相关性(P=0.014)。难治复发组的CXCR4阳性率(81%)显著高于无复发组(28%,P<0.001)。单因素分析显示:CXCR4阳性表达的患者中位数肿瘤无进展生存时间和总生存时间(15个月、27个月)明显短于CXCR4阴性表达者(>21个月、>32个月,分别为P<0.001和P=0.017)。多因素分析显示:CXCR4表达和残余灶大小是影响卵巢上皮性癌患者的肿瘤无进展生存时间和总生存时间的独立预后因素。结论:CXCR4在卵巢上皮性癌中的表达阳性率较高,是影响其预后的独立指标之一。     

58例晚期卵巢癌患者发生腹腔内转移后的临床特征、疗效及预后影响因素分析

目的 探讨晚期卵巢癌患者发生腹腔转移后的临床特点、疗效,并探讨预后的影响因素。方法 回顾性分析湖北省天门市第一人民医院肿瘤科3个病区2013年1月—2016年1月期间病理诊断明确、初诊且临床资料齐全的65例晚期卵巢癌患者,其中发生腹腔转移的58例,对58例患者预后影响因素进行单因素和多因素生存分析。结果 58例诊断卵巢癌腹腔转移患者的平均年龄为(49.2±6.5)岁,从确诊卵巢癌到发生腹腔转移的平均时间为11个月,卵巢癌腹腔转移患者的中位生存时间为8周,而7例未发生腹腔转移者的中位生存时间为15周。单因素生存曲线比较显示,患者婚姻状况、生育史、哺乳史、恶性腹水、新辅助化疗、综合治疗(化疗+开腹的肿瘤细胞减灭术+腹腔热灌注化疗)、腹腔转移瘤数目、残余病灶大小、患者的生存质量(卡氏评分)、血浆中D-二聚体水平、尿液中微量白蛋白的水平与患者的预后均有关(P＜0.05)。Cox多因素回归模型分析显示,患者生育史、综合治疗、血浆中D-二聚体的水平、尿液中微量白蛋白水平为影响患者预后的独立危险因素(P＜0.05)。结论 晚期卵巢癌腹腔转移患者生存时间短,预后差;新辅助化疗联合肿瘤细胞减灭术及术后腹腔热灌注化疗,短期疗效好,既能提高晚期卵巢癌治疗有效性,又可改善晚期患者的生存质量;治疗前血浆中D-二聚体水平以及尿液中微量白蛋白持续维持在高水平或者不降低的患者,治疗效果差,预后也差,提示二者可以作为一种新的判断预后的指标。     

卵巢转移瘤109例临床分析

:[目的]了解卵巢转移瘤的临床特征 ,探讨其治疗和预后。[方法]对1985年～1996年109例卵巢转移瘤病人进行回顾性分析。[结果]109例卵巢转移瘤占同期收治的卵巢恶性肿瘤的9 7% ,双侧卵巢转移占62 4% ,单侧卵巢转移占37 6% ,伴腹腔转移占71 6%。1年生存率5 0% ,平均生存时间13个月。来源于乳腺癌、淋巴瘤和生殖道癌的卵巢转移瘤平均生存时间为27个月、32个月和22个月 ,来源于结肠癌、胃癌和肺癌的平均生存时间为9个月、8个月和3个月。肿瘤局限在盆腔内的平均生存时间比腹盆腔广泛转移的明显延长(21个月比9个月) ,有显著的统计学意义(P<0 01)。胃肠道和生殖道癌卵巢转移术后残存肿瘤的直径<2cm(理想肿瘤细胞减灭术)的平均生存时间明显长于>2cm者 ,亦有显著的统计学意义(P<0 01)。[结论]卵巢转移瘤常合并腹盆腔广泛转移 ,预后差 ,但手术达理想减瘤者可以明显延长生存     

Radical surgical procedure improves survival time in patients with recurrent ovarian cancer.

BACKGROUND. There is plenty of evidence that survival time associated with advanced ovarian cancer is predominantly related to the amount of residual tumor after primary operation. However, there are only few and inconclusive reports concerning the effect of second debulking procedures on survival time after relapse. METHODS. To evaluate the effect of radical second operation, 30 patients with clinically diagnosed relapses had second operations after a median recurrence-free interval of 16 months. Considerable efforts were made to resect all tumor tissue. Complete resection was achieved in 14 of 39 (47%) patients, and residual tumors smaller than 2 cm remained in 12 (40%) patients. In 19 (63%) patients, intestinal resections were necessary. Operation time, blood units needed, hospital stay, and complication rates were comparable to those associated with primary debulking procedures. RESULTS. Survival time after second operation was closely correlated with the residual tumor remaining after second surgical procedure and also with the length of the recurrence-free interval. Patients with complete resections had significantly longer survival times than those with residual tumors of less than 2 cm (median, 29 months versus 9 months; P = 0.004). Patients with a recurrence-free interval of more than 12 months had a longer survival time than those with a shorter disease-free time (median, 29 months versus 8 months; P = 0.002). Postoperative treatment also was shown to influence survival time, whereas grade of the tumor (P = 0.74), age of the patient (P = 0.87), and initial FIGO stage (P = 0.58) had no influence on survival time after second operation. Multivariate analysis (Cox regression) revealed that residual tumor after second surgical procedure (relative risk, 4.7) was the most important independent variable predicting survival time after second surgical procedure. Recurrence-free interval (relative risk, 2.7) and postoperative (second-line) treatment (relative risk, 3.0) were equally potent variables. Residual tumor after primary operation, was almost significant (P = 0.06) in the univariate analysis, but was canceled in the multivariate setting by the recurrence-free interval. Again, FIGO stage, grade of the tumor, and patient age had no predictive value. CONCLUSIONS. The authors conclude that radical surgical procedure can prolong survival times in patients with recurrent ovarian cancer. Patients who had a complete resection of cancer tissue in the primary operation or those who experienced a disease-free interval of more than 12 months after primary operation are most likely to benefit from second operation in recurrent ovarian cancer. Radical surgical procedure should be offered to these patients to enhance efficacy of second-line chemotherapy, which is of limited value in bulky recurrent disease.     

Pulmonary resection for metastatic colorectal cancer

We reviewed the clinical courses of 25 patients who underwent pulmonary resection for metastatic lesions from colorectal cancer between January 1991 and December 2001. The cumulative survivals at 3 and 5 years were 72% and 63%, respectively. Sex, site of the primary tumor, presence of extrapulmonary metastases, disease-free interval, location of pulmonary metastases (PM), number of PM, size of PM, mode of operation, pre-thoracotomy serum carcinoembryonic antigen level, and post-thoracotomy chemotherapy were not found to be statistically significant prognostic factors. Age (70 years < or =) was a predictor of a shorter survival duration by univariate analysis (p = 0.02). Recurrence was observed in 19 patients, 11 of which were lung recurrences. Eight patients underwent repeated pulmonary resection. The median survival in these 8 patients was 23 months after second pulmonary operation. Surgical treatment for pulmonary metastases from colorectal cancer in selected patients might improve prognosis.     

Role of Neoadjuvant Chemotherapy in the Management of Advanced Ovarian Cancer

Objective: To analyze efficacy of neoadjuvant chemotherapy for advanced ovarian cancer. Materials andMethods: A total of 107 patients with advanced ovarian cancer undergoing cytoreductive surgery were dividedinto a neoadjuvant chemotherapy group (n=61) and a primary debulking group (n=46) and retrospectivelyanalyzed. Platinum-based adjuvant chemotherapy was applied to both groups after cytoreductive surgery andeoverall and progression-free survival times were calculated. Results: No significant difference was observed induration of hospitalization (20.8±6.1 vs. 20.2±5.4 days, p>0.05). The operation time of neoadjuvant chemotherapygroup was shorter than the initial surgery group (3.1±0.7 vs. 3.4±0.8 h, p<0.05). There were no significantdifferences in median overall survival time between neoadjuvant chemotherapy group and surgery group (42 vs.55 months, p>0.05). Similarly, there was no difference in median progression-free survival between neoadjuvantchemotherapy group and surgery group (16 vs. 17 months, p>0.05). The surgical residual tumor size demonstratedno significant difference between initial surgery and neoadjuvant chemotherapy groups (p>0.05). Multivariateanalysis showed that more than 3 cycles of regimen with neoadjuvant chemotherapy was associated with moreresistance to chemotherapy compared with patients without receiving neoadjuvant chemotherapy (OR: 5.962,95%CI: 1.184-30.030, p<0.05). Conclusions:Neoadjuvant chemotherapy can shorten the operation time. However,it does not improve survival rates of advanced ovarian cancer patients.     

Advanced ovarian cancer

Opinion statement Ovarian cancer spreads early in the disease into the abdomen. An en bloc resection of the tumor, according to surgical principle, is not possible in patients with highstage ovarian cancer. At surgery, large pelvic tumor lesions are found together with multiple tumor lesions involving the omentum, bowel, and mesentery together with a diffuse peritoneal carcinomatosis and diaphragmatic involvement. A multimodality approach with cytoreductive surgery and taxol platinum-based chemotherapy is therefore the mainstay of treatment of advanced ovarian cancer. The size of residual disease after surgery is one of the most important prognostic factors for survival. Patients with an optimal tumor cytoreduction (residual lesions smaller than 1 cm) have a significant longer survival (almost two times the median survival) than patients with larger residual lesions [1-5]. This holds true even for patients with International Federation of Gynecology and Obstetrics (FIGO) stage IV disease [6-10]. Patients in whom all macroscopic tumor is resected do have the longest survival. The 2-year survival of patients with a radical resection of all macroscopic tumors is 80%, in contrast to less than 22% for the patients with lesions larger than 2 cm [4]. An optimal primary cytoreductive surgery can generally be performed in 30% to 50% of patients [11]. Only in more experienced gynecologic oncology centers is the percentage as high as 85%, but sometimes at the cost of an increased morbidity and even mortality [12,13,14-16,17]. The worse prognosis of the patients with a suboptimal primary cytoreductive surgery can be improved by an interval cytoreductive surgery after platinum-containing induction chemotherapy [18,19]. The median survival and progression-free survivals are significantly lengthened by cytoreductive surgery. After more than 5-years follow-up there is still a significant survival benefit: the 5-year survival of the surgery patients was 24% versus 13% for the no-surgery patients (P = 0.0032). All patients, including those with unfavorable prognostic factors (stage IV disease, peritonitis carcinomatosis, or ascites at primary surgery), and even patients with stable disease after induction chemotherapy, seem to benefit from interval cytoreductive surgery. The increase in progression-free survival and overall survival does outweigh the morbidity associated with interval debulking surgery, which is not different from those associated with primary surgery.     

影响卵巢恶性生殖细胞肿瘤保留生育功能手术患者预后的因素分析

目的 探讨影响卵巢恶性生殖细胞肿瘤保留生育功能手术患者预后的相关因素。方法 回顾性分析1986年1月1日至2010年12月31日广西医科大学附属肿瘤医院妇瘤科收治的卵巢恶性生殖细胞肿瘤（malignant ovarian germ cell tumors,MOGCT）保留生育术患者的临床资料及随访结果,以Kaplan-Meier法绘制生存曲线,并比较单因素中不同因素影响生存时间的差异,其差异性经Log rank检验,并用Cox模型进行多因素回归分析,用Logistic回归分析不同因素对生育能力的影响。结果 60例患者中位年龄20（9~34）岁,中位随访时间41.5（2~237）月,复发4例,死亡9例。31例患者怀孕并生育健康婴儿。单因素分析显示病理类型、术后残留病灶大小、化疗疗程、对侧卵巢活检、淋巴结切除及大网膜切除等与预后相关,而对患者生育无明显影响。多因素分析显示仅有术后残留病灶大小是影响患者无瘤生存及长期生存的独立因素。结论 术后残留病灶大小可影响MOGCT患者的预后,全面分期手术对预后无明显改善。MOGCT保留生育手术后生存率较高,生育能力亦得到较好保存。     

肝脏部分切除术在复发性上皮性卵巢癌肝实质转移治疗中的价值

目的 探讨复发性上皮性卵巢癌肝实质转移患者行肝脏部分切除术的临床价值.方法 回顾性分析39例复发性上皮性卵巢癌肝实质转移患者的临床病理资料.结果 39例患者中,10例进行了肝脏部分切除术,29例仅行挽救性化疗.手术组患者的病变均为单叶,且病灶＜3个,与化疗组比较,差异有统计学意义(P＜0.05),在年龄、初次手术病理类型及病理分级、初次减瘤手术结果、初次治疗后的无瘤生存时间、肝转移瘤大小及肝转移时CA125水平等方面,差异均无统计学意义(P＞0.05).10例手术患者中,单纯行肝脏手术6例,同时行其他部位肿瘤细胞减灭术4例,其中7例减瘤手术满意.3例发生手术并发症,无手术死亡病例.8例肝脏病理切缘为阴性的患者中,局部复发6例,中位复发时间为术后12个月.减瘤手术满意的患者与行挽救性化疗的患者,肝转移后的中位总生存时间分别为26个月和9个月,肝转移后3年累积生存率分别为60.0%和16.8%,两组比较,差异有统计学意义(P＜0.05).结论 对存在肝实质转移的复发性上皮性卵巢癌患者施行包括肝脏部分切除术在内的满意肿瘤细胞减灭术,术后辅以化疗,有可能改善患者的预后.

Abstract：

Objective To investigate the validity of hepatic resection as a treatment option for hepatic parenchymal metastasis in patients with recurrent epithelial ovarian cancer. Methods A retrospective review of the clinicopathological and follow up data of 39 patients treated in our hospital from 1996 to 2008was conducted. Results Ten patients underwent partial hepatic resection for metastatic ovarian cancer.All the 10 patients underwent surgery were with unilobar metastasis and the number of tumors was lower than 3 (P ＜0.05).No significant difference existed in patient age,the primary pathology type and tumor grade,the rate of optimal primary cytoreductive surgery,the disease free survival after the primary therapy and the serum CA125 level at the liver metastasis when compared with the 29 patients accepted salvage chemotherapy(P ＞0.05).There were 7 patients who achieved optional surgery.The operation complication was 3/10 andthere was no perioperative mortality.There were 2 patients without postoperative chemotherapy in the 8 recurrent patients with microscopic negative margins.The median recurrence time was 12(5-24) months after the hepatic resection.The overall median survival periods after hepatic metastasis were 26 and 9 months and the 3-years cumulative survival rates were 60.0% and 16.8% for the optimal surgery patients including hepatic surgery and the salvage chemotherapy patients,respectively(P ＜0.05).Conclusion Hepatic resection for liver metastatic epithelial ovarian cancer is safe and may achieve long-term survival in patients after optimal second cytoreductive surgery.