卵巢癌术后腹腔化疗的临床研究

目的探讨腹腔化疗在卵巢癌患者术后化疗中的价值。方法对88例卵巢上皮癌患者随机分组，动态观察血清CA125并随诊，进行回顾性分析。结果腹腔及静脉化疗组的血清CA125衰减程度及3年生存率均优于静脉化疗组，二者相比较P〈0．05，有统计学意义。结论腹腔与静脉联合化疗优于单纯的静脉注射化疗。     

腹腔灌注卡铂联合静脉化疗治疗复发性卵巢癌

近年我们行腹腔灌注卡铂联合静脉化疗治疗中晚期恶性卵巢癌25例,取得了一定疗效。材料和方法一　病例选择　所有病例都是经过手术切除后,病理证实的有复发、转移的恶性卵巢癌病人25例。临床分期参照1988年ＦＩＧＯ制定的卵巢恶性肿瘤分期标准确定。其中Ⅲａ1例,Ⅲｂ2例,Ⅲｃ5例,Ⅳ17例。年龄45—65岁,中位年龄为523岁;病程6月—72月,平均病程323月;病理为浆液性乳头状囊腺癌10例,粘液性囊腺癌5例,腺癌7例,颗粒细胞癌2例,透明细胞癌1例;盆腔转移15例,腹腔转移合并腹水20例,肝转移3例,脾转移1例,肺转移3例,左胸水3例,双侧胸水2例,左锁骨上窝淋…     

腹腔热灌注联合静脉化疗治疗晚期卵巢癌的临床观察

目的:探讨腹腔热灌注联合静脉化疗治疗晚期卵巢癌的疗效及不良反应。方法:将2005年5 月～2009年2 月收治的90例经病理学或细胞学确诊的Ⅲ～Ⅳ期卵巢癌患者采用信封法随机分为腹腔热灌注联合静脉化疗组50例（治疗组）和单纯静脉化疗组40例（对照组）,治疗组采用顺铂腹腔热灌注联合紫杉醇静脉化疗,对照组采用紫杉醇联合顺铂静脉化疗,观察两组的肿瘤控制率、腹水控制率及不良反应。结果:两组的肿瘤控制率（CR+PR）分别为72% 和47.5% ,差异具有统计学意义（P=0.018）,两组的腹水控制率（CR+PR）分别为80% 和50% ,差异具有统计学意义（P=0.014）,两组Ⅲ～Ⅳ度不良反应发生率分别为38% 和40% ,差异无统计学意义（P=0.847）。 结论:腹腔热灌注联合静脉化疗治疗晚期卵巢癌的疗效优于单纯静脉化疗,且不良反应能够耐受,值得临床推广。      

卵巢癌术后腹腔化疗病人的护理

临床上大多数卵巢癌病人初次诊断已属晚期 ,而且其播散转移主要位于腹腔内[1] 。随着肿瘤治疗学的进展 ,目前 ,腹腔化疗对于卵巢癌病人的治疗已广泛应于用临床。本院肿瘤外科自 1997年 7月至 2 0 0 1年 6月 ,对 2 8例中晚期卵巢癌术后病人进行腹腔化疗 ,取得了较满意的效果 ,现将护理体会总结如下。1　资料与方法1 1　一般资料　本组 2 8例 ,按国际妇产科联盟FIGO分期 ,Ⅱ期 4例 ,Ⅲ期 2 4例 ,年龄 31～ 77岁 ,平均 5 0岁 ,均行肿瘤减灭术 ,并经病理学诊断证实。治疗前后均作CT、B超检查 ,显示有效 18例 (64 3% )。1 2　常用化疗方案　术…     

高精度持续循环腹腔热灌注化疗联合静脉化疗治疗卵巢癌的临床研究

目的：探讨高精度持续循环腹腔热灌注化疗（HIPEC）联合静脉化疗治疗卵巢癌的临床疗效。方法入组卵巢癌患者198例,分为2组,其中治疗组120例（HIPEC 联合紫杉醇＋奥沙利铂方案静脉化疗组）、对照组78例（紫杉醇＋奥沙利铂方案静脉化疗组）。观察2组患者的生存时间、病死率、复发率、生活质量及化疗毒副反应。结果治疗组患者术后1 a、2 a、3 a 病死率及复发率明显低于对照组,而平均生存时间高于对照组（P ＜005）。结论 HIPEC 联合静脉化疗能有效降低卵巢癌患者术后复发率及病死率,提高生活质量,延长其生存时间。     

腹腔温热化疗对卵巢癌术后复发的影响

目的：评估腹腔温热化疗对卵巢癌患者术后腹腔内复发的影响，探索防治方法。方法：随机分为腹腔温热化疗组(温热组)27例和腹腔常温化疗组(常温组)23例。分别于术后1周始进行腹腔温热及常温灌注化疗，观察两组血清CAl25变化及腹腔冲洗液细胞学检查结果，对比两组1、3年生存率。结果：第3次化疗前血清CAl25值较术前下降50％以上者，温热组占81．5％，常温组占65．2％。末次化疗前腹腔；中洗液细胞学检查两组均阴性。两组1、3年生存率分别为88．9％、65．2％；81．8％、52．1％。结论：腹腔温热灌注化疗对卵巢癌术后复发有良好的防治作用，术后早期应用可明显提高疗效。     

经腹腔和静脉双途径应用紫杉醇化疗治疗晚期卵巢癌

目的：观察并评价紫杉醇(泰素)加顺铂经腹腔和静脉化疗治疗晚期卵巢癌的近期疗效及其毒副反应。方法：8例Ⅲ或Ⅳ期卵巢癌患接受泰素40mg／m^2 顺铂20～40mg／m^2腹腔注入,泰素40mg／m^2静脉滴注,每周1次,连用3周为一疗程,2个疗程后进行评价。结果：全组8例患中获得PR4例,总有效率50％;控制腹水的有效率达100％。结论：泰素和顺铂经腹腔和静脉化疗治疗晚期卵巢癌疗效肯定,毒副反应轻,值得临床进一步研究和应用。     

卵巢癌腹腔化疗的进展

卵巢癌是妇科恶性肿瘤中病死率最高的疾病,探索有效的治疗方法以提高卵巢癌的生存率、降低其病死率是妇科肿瘤学者所面临的首要问题。由于卵巢癌最常见的转移途径为腹腔内播散种植,因此腹腔化疗凭借其特有的优势已受到广泛关注。现就卵巢癌腹腔化疗的进展进行综述。     

腹腔热灌注联合静脉化疗治疗晚期卵巢癌的疗效观察

目的:探讨晚期卵巢癌行腹腔热灌注联合静脉化疗的临床疗效及不良反应。方法:2008年12月-2012年12月收治 的100例晚期卵巢癌并大、中量腹腔积液患者采用信封法随机分为治疗组和对照组。治疗组60例,行腹腔热灌注联合静脉化疗;对照组40例,行单纯的静脉化疗。治疗组采用顺铂腹腔热灌注联合紫杉醇静脉化疗,对照组采用紫杉醇联合顺铂 静脉化疗,观察两组的腹水控制率及不良反应。结果:治疗组的腹水控制率为78.3%,对照组为42.5%,差异具有统计学 意义（P＜0.01）。两组的不良反应比较无统计学差异（P＞0.05）。结论:腹腔热灌注联合静脉化疗可有效的控制卵巢 癌患者恶性腹腔积液,不良反应能够耐受。     

草酸铂治疗上皮性卵巢癌

目的 探讨草酸铂为主的化疗对上皮性卵巢癌的疗效及毒副作用。方法 回顾性分析了2000年5月1日至2002年12月31日收治的39例上皮性卵巢癌使用草酸铂的资料。结果 39例患者中30例可评价疗效,其中初治患者9例,复发患者21例。初治者的近期疗效为PR 88.9％(8/9)。复发患者中铂敏感者的有效率为55.6％(5/9),其中CR 22.3％(2/9),PR 33.3％(3/9);铂耐药者的有效率为PR 16.7％(2/12)。7例有效的复发者中,2例CR患者的无瘤缓解期分别为12个月和15个月,5例PR患者的中位缓解期为4个月。感觉神经毒性的发生率为15.4％(6/39),骨髓抑制23.0％(9/39),肾脏毒性5.1％(2/39),胃肠道反应25.6％(10/39)。结论草酸铂为主的化疗对铂耐药或铂敏感的复发卵巢癌均有一定的疗效;用于卵巢癌的一线化疗亦有较好的近期疗效,其毒性作用一般可耐受。     

CT引导下125I 粒子植入联合化疗治疗复发性卵巢癌

目的:探讨CT引导下125I 粒子植入联合化疗治疗复发性卵巢癌患者的临床疗效及安全性。方法:回顾性分析采用125I粒子植入联合化疗治疗的21例复发性卵巢癌患者资料。共29处可评价病灶,其中25处适合125I 粒子植入治疗。应用治疗计划系统制定125I 粒子植入计划,在CT引导下植入粒子。粒子植入术后3 d 内行紫杉醇脂质体静脉化疗,次日经肿瘤供血动脉灌注卡铂,每3 周重复1 次,随访观察治疗效果及并发症。结果:2 个疗程化疗结束后125I 粒子植入治疗的25处病灶中完全缓解（CR）为16%（4/25）、部分缓解（PR）为56%（14/25）、疾病稳定（SD）为12%（3/25）、疾病进展（PD）为16%（4/25）,总有效率（CR+PR）为72%（18/25）,疼痛缓解率为82.4%（14/17）,KPS 评分较治疗前升高（P=0.019）。 中位无进展生存时间（PFS）为6.8 个月,中位生存时间（OS）为14.2 个月,1 年生存率为42.9%（9/21）,主要为血液学及消化道不良反应,所有患者未发生严重的放射性损伤并发症。结论:125I粒子植入治疗联合化疗能够提高复发性卵巢癌患者的临床缓解率,改善临床症状,并且耐受性良好。      

CA 125 regression after two completed cycles of chemotherapy: lack of prediction for long-term survival in patients with advanced ovarian cancer

The prognostic influence of CA 125 regression between the time point before surgery and after two completed courses of chemotherapy was studied in 210 patients with advanced ovarian cancer, and was compared to other well established prognostic factors. CA 125 blood samples were collected preoperatively (CA 125 pre) and 3 months after surgery (CA 125 3 mo) (at the beginning of the 3rd cycle of chemotherapy). The parameter CA 125 regression defined as log10 (CA 125 3 mo/CA 125 pre) was used for statistical analysis. In a survival analysis using a Cox proportional hazards model, CA 125 regression (P = 0.0001), residual tumour (P = 0.0001), age (P = 0.0095) and grading (P = 0.044) were independent variables, whereas stage of disease, histology, ascites and type of surgery failed to retain significance. Using log10 (CA 125 3 mo/CA 125 pre) as simple covariate in a Cox model showed a hazard ratio of 1.70 (95% confidence interval 1.32-2.19, P = 0.0001). However, a detailed analysis of the interaction of time with the prognostic factor CA 125 regression on survival revealed a strong time-dependent effect with a hazard ratio of more than 6 immediately after two courses of chemotherapy, whereas within approximately 1 year the hazard ratio for the surviving patients dropped quickly to the neutral level of 1. In summary, CA 125 regression is an independent prognostic factor for survival of women with advanced ovarian cancer and allows an identification of a high-risk population among patients with advanced ovarian cancer. However, the discriminating power of serial CA 125 for long-term survival seems to be temporary and prediction of individual patients outcome is far less precise.     

上皮性卵巢癌患者手术及化疗前后血清中人附睾蛋白4和糖类抗原125的变化

目的探讨上皮性卵巢癌患者手术及化疗前后血清中人附睾蛋白4(HE4)和糖类抗原125(CA125)的变化。方法选取2012年3月至2013年3月间收治的50例上皮性卵巢癌患者,采用酶联免疫吸附试验(ELISA)检测50例上皮性卵巢癌患者(研究组)手术及化疗前后、正常健康人群(健康组)及卵巢良性肿瘤患者(对照组)血清中HE4和CA125水平,探讨其在疾病预后的的价值。结果对照组患者CA125和HE4水平显著高于健康组,差异有统计学意义(P<0.05)。研究组患者术前CA125和HE4水平明显高于对照组和健康组,其中化疗3个疗程后血清CA125水平降至正常水平,化疗2个疗程后血清HE4水平降至正常水平。CA125阴转符合率为41.5%,HE4阴转符合率为75.6%,CA125+HE4联合检测阴转符合率则增至85.4%;联合检测阳转符合率高达100%。结论血清CA125和HE4联合检测对卵巢癌预后判断有重要指导意义,可作为卵巢癌病情检测指标之一。     

CA 125 half-life and CA 125 nadir during induction chemotherapy are independent predictors of epithelial ovarian cancer outcome: results of a French multicentric study.

BACKGROUND: CA 125 assays enable treatment-response monitoring in ovarian cancer. PATIENTS AND METHODS: A multicentric study of CA 125 kinetics under induction chemotherapy was performed in 631 patients. CA 125 half-life was calculated by mono-compartmental logarithmic regression. Nadir CA 125 concentration and time to nadir were also studied. Survival analyses for disease-free survival (DFS) and overall survival (OS) used univariate (Kaplan-Meier) and multivariate (Cox) models. RESULTS: For 553 stage IIC-IV patients, 459 (83.0%) relapsed and 444 (80.3%) died from cancer. Median (range) follow up time was 32 months (2-214 months). Median (range) for CA 125 kinetics were: 263 kU/l (5-52000 kU/l) before 1st course, 15.8 days (4.5-417.9 days) for CA 125 half-life, 16 kU/l (3-2610 kU/l) for nadir and 85 days (0-361 days) for time to nadir. Pre-chemotherapy CA 125, its half-life, nadir concentration and time to nadir all had a univariate prognostic value for DFS and OS (P<0.0001). In Cox models, CA 125 half-life, residual tumour (P<0.0001 for both), nadir concentration (P=0.0002) and stage (P=0.0118) were the most powerful prognostic factors for DFS. For OS, the significant variables were similar, with age ranking last (P=0.0319). CONCLUSION: Among well-established prognostic factors in ovarian cancers, CA 125 half-life and nadir concentration bear a strong and independent prognostic value.     

新辅助化疗联合手术治疗晚期卵巢癌近期及远期疗效观察

目的探讨新辅助化疗联合手术治疗在治疗晚期卵巢癌中的作用和疗效。方法选择60例晚期卵巢癌患者作为研究对象,按照不同治疗方法分为两组,30例患者[新辅助化疗组（NACT）组]采用新辅助化疗,然后进行肿瘤减灭术;另外30例患者（对照组）首先行肿瘤减灭术,再行化疗。结果NACT组理想肿瘤减灭率为73．3％,对照组为36．7％,两组比较差异有统计学意义（P〈0．05）;NACT组术中出血量及手术时间较对照组少（短）,两组比较差异有统计学意义（P〈0．05）;合并脏器切除率分别为16．7％和20．0％,并发症发生率为13．3％和20．0％,组间比较差异无统计学意义（P〉0．05）;新辅助化疗组的中位生存时间（37月）较先期手术组（30月）长,1年生存率分别为90．0％和83．3％（P〉0．05）,3年生存率分别为50．0％和26．7％（P〉0．05）。结论对晚期卵巢癌患者行新辅助化疗有助于提高患者的手术效果和近期生存率,具有较好的临床安全性。     

Role of chemotherapy in the management of epithelial ovarian cancer

The management of ovarian cancer continues to provide major challenges and debates about optimal treatment. For first-line therapy there remain discussions about optimal chemotherapy for early disease, the use of taxanes as standard for advanced newly diagnosed patients, whether there is a definite role for neoadjuvant chemotherapy and the question of maintenance treatment. For relapsed disease, the management hinges around the distinction between platinum-sensitive and -resistant cancer, and the recent AGO-2.5 and ICON-4 studies suggest that treating with carboplatin and paclitaxel or carboplatin and gemcitabine is recommended. Intraperitoneal chemotherapy remains an enigma with at least three studies showing survival advantage; however, there has been no move to incorporate it into standard management of those patients who achieve complete remission after first-line chemotherapy. Finally, neoadjuvant chemotherapy prior to debulking surgery is the subject of several ongoing clinical trials and may turn out to be one of the most important developments since the concept of interval debulking surgery was established and proven in Europe.     

CA‐125 change after chemotherapy in prediction of treatment outcome among advanced mucinous and clear cell epithelial ovarian cancers

BACKGROUND:

There are limited data regarding unique clinical or laboratory features associated with advanced clear cell (CC) and mucinous (MU) epithelial ovarian cancers (EOC), particularly the relationship between CA‐125 antigen levels and prognosis.

METHODS:

A retrospective review of 7 previously reported Gynecologic Oncology Group phase 3 trials in patients with stage III/IV EOC was conducted. A variety of clinical parameters were examined, including the impact of baseline and changes in the CA‐125 level after treatment of CC and MU EOC on progression‐free (PFS) and overall survival (OS).

RESULTS:

Clinical outcomes among patients with advanced CC and MU EOC were significantly worse when compared with other cell types (median PFS, 9.7 vs 7.0 vs 16.7 months, respectively, P < .001; median OS, 19.4 vs 11.3 vs 40.5 months, respectively, P < .001). Suboptimal debulking was associated with significantly decreased PFS and OS among both. Although baseline CA‐125 values were lower in CC (median, 154 μ/mL) and MU (100 μ/mL), compared with other cell types (275 μ/mL), this level did not appear to influence outcome among these 2 specific subtypes of EOC. However, an elevated level of CA‐125 at the end of chemotherapy was significantly associated with decreased PFS and OS (P < .01 for all).

CONCLUSIONS:

Surgical debulking status is the most important variable at prechemotherapy predictive of prognosis among advanced CC and MU EOC patients. Changes in the CA‐125 levels at the end treatment as compared with baseline can serve as valid indicators of PFS and OS, and likely the degree of inherent chemosensitivity. Cancer 2009. © 2009 American Cancer Society.     

Difference in mesothelin‐binding ability of serum CA125 between patients with endometriosis and epithelial ovarian cancer

The epithelial ovarian carcinoma (EOC) is an aggressive malignant tumor, and is currently the leading cause of gynecologic cancer death. CA125 is the most commonly used serum marker for EOC, but shows a high‐false‐positive rate for several benign diseases such as endometriosis. The purpose of our study is therefore to identify a useful biochemical tool for detecting qualitative differences between CA125 from patients with endometriosis and EOC, and to facilitate differential diagnosis of these diseases. In our study, using two different CA125‐binding molecules, i.e., recombinant mesothelin and an anti‐CA125 monoclonal antibody, a novel sandwich ELISA for determining the serum levels of CA125 with mesothelin‐binding ability (CA125^meso) was developed, and tested for patients with endometriosis (n = 59) and EOC (n = 36). We found that both the serum CA125^meso level and the ratio of the serum CA125^meso to CA125 levels (CA125^meso/CA125) were significantly higher in patients with EOC than in patients with endometriosis (p < 0.00005 and p < 0.000001, respectively). Furthermore, receiver operating characteristic analysis showed that the CA125^meso assay was superior to the conventional antibody‐based CA125 assay in discriminating endometriosis from EOC. Thus, mesothelin‐binding ability may be a useful indicator for qualitatively evaluating CA125 in patients with endometriosis and EOC.