Ⅳ期上皮性卵巢癌的生存率及其影响因素分析

目的　探讨 期上皮性卵巢癌患者的生存率及其影响因素。方法　对该医院近 10年内有较细致随访资料的 31例上皮性卵巢癌进行回顾性分析。结果　 1单因素分析表明 ,是否手术、化疗疗程数、肿瘤残留病灶大小、肿瘤组织学类型、转移部位以及分化程度均显著影响 期卵巢癌的生存率 (P<0 .0 5 )。2建立的 COX模型发现 ,化疗疗程数达到 8次和残留病灶≤ 2 cm两因素能分别降低死亡风险概率 0 .2 8和 0 .72 ,而未行手术、远处淋巴结转移及肝脏转移会增加死亡风险概率 ,其相对风险度分别是手术者、无远处淋巴结转移者及无肝脏转移者的14.2 5倍、11.44倍和 1.85倍。该模型预测 期上皮性卵巢癌患者的中位生存时间为 16 .8± 6 .5月。结论　应尽早采用彻底的缩瘤手术和积极、适宜的化疗等综合性治疗措施 ,以改善病人生活质量和提高生存率。     

Effect of retroperitoneal lymphadenectomy on prognosis of patients with epithelial ovarian cancer

Objective To evaluate prognostic factors which have an influence on overall survival and to assess the rational application of retroperitoneal lymphadenectomy in patients with epithelial ovarian cancer. Methods The data of 131 patients treated between January 1990 and December 1998 in Union Hospital and Tongji Hospital were analyzed retrospectively. Survival was calculated using the Kaplan-Meier method and comparisons were performed using Log-rank test. Independent prognostic factors were identified by the Cox proportional hazards regression model. Results Univariate analysis showed that age, general conditions, menopausal status, stage, pathological types, location of the tumor, residual tumor and retroperitoneal lymphadenectomy were prognostic factors. Multivariate analysis showed that age, stage, residual tumor, retroperitoneal lymphadenectomy and the number of courses of chemotherapy were the most important prognostic factors. The survival rate could not be improved through retroperitoneal lymphadenectomy in the patients in early stage, advanced stage with residual tumor &gt;2 cm or those with mucinous adenocarcinoma （P&gt;0.05). Among patients in advanced stage cancer with a residual tumor ≤2 cm, 5-year survival was 65% and 30% for patients who did and did not undergo lymphadenectomy, respectively （P&lt;0.01). Among patients with serous adenocarcinoma, 5-year survival was 61% and 31% for patients who did and did not undergo lymphadenectomy, respectively （P&lt;0.01). Conclusions The prognosis of the patients with epithelial ovarian cancer may be influenced by age, stage, residual tumor, retroperitoneal lymphadenectomy and the number of courses of chemotherapy. Although retroperitoneal lymphadenectomy could improve the survival rate, it should be carried out selectively.     

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。     

Ⅲ期卵巢上皮性癌临床和预后因素分析

目的探讨Ⅲ期卵巢上皮性癌的预后因素,为进一步的合理治疗提供依据。方法回顾性分析北京协和医院妇产科自1993年1月1日至2002年12月31日收治的Ⅲ期卵巢上皮性癌患者369例的临床资料,利用SPSS10.0统计软件对可能与预后相关的因素进行多因素分析。结果369例患者中,平均年龄为53岁±9岁(22~77岁),所有患者均在我院接受了肿瘤细胞减灭术,其中289例(78.3%)达到理想的肿瘤细胞减灭,术中发现肠管受累150例(41.8%),横膈受累265例(71.8%),290例患者接受了淋巴结切除,其中179例(61.7%)淋巴结受累。浆液性癌是最常见的组织学类型,占48.9%(175例),黏液性癌最少见,占2.2%(8例),组织学分级G1、G2、G3分别为1.7%(6/358)、42.7%(153/358)和55.6%(199/358)。术后有290例有效病例接受了10个±4个疗程(3~22个疗程)的化疗,369例患者中有记载的复发病例190例(51.5%),有记载的死亡病例152例(41·2%)。对于可能和预后有关的因素进行多因素分析,发现肠管受累(P<0.01)、横膈受累(P<0.05)、手术彻底性(P<0.01)、化疗疗程数(P<0.01)与预后存在着良好的相关性。结论重视腹腔内肿瘤的减灭和术后积极、有效的化疗可能对于改善Ⅲ期卵巢上皮性癌的预后有利。     

影响卵巢上皮性癌预后的因素分析

目的探讨影响卵巢上皮性癌预后的因素。方法对唐山市7所大型医院10年间经手术治疗的113例卵巢上皮性癌病例,采用COX回归模型进行了单因素和多因素分析。结果COX回归模型中包括的因素有临床分期、术后残留灶大小、化疗疗程数。结论分期早、彻底手术并辅助足够疗程可以改善卵巢上皮性癌的预后。     

REDD1、Bcl-2在50例卵巢高级别浆液性癌中的表达及临床意义

目的:在我们前期体外细胞和裸鼠成瘤实验研究结果的基础上,检测新癌基因REDD1和Bcl-2在人卵巢高级别浆液性癌组织中的表达,分析其与临床病理因子之间的关系及二者的相关性.方法:应用免疫组织化学链霉素抗生物素-过氧化物酶复合法(S-P)检测REDD1、Bcl-2在50例卵巢高级别浆液性癌组织中的表达.结果:REDD1在Ⅲ、Ⅳ期高级别浆液性癌组织中的表达明显高于Ⅰ～Ⅱ期(P＜0.05),在有腹水病例组中的表达高于无腹水组(P＜0.05);Bcl-2在Ⅲ、Ⅳ期高级别浆液性癌组织中的表达明显低于Ⅰ～Ⅱ期(P＜0.05),在无腹水的病例组中的表达高于有腹水组(P ＜0.05);REDD1和Bcl-2在卵巢癌组织中的表达与化疗反应无关(P＞0.05).结论:REDD1、Bcl-2可能参与了卵巢高级别浆液性癌的发生,联合检测二者的表达可能有助于卵巢癌临床预后的评估.     

腹膜后淋巴结清扫在卵巢上皮癌治疗中的价值

目的探讨卵巢上皮癌腹膜后淋巴结清扫的临床价值。方法对289例卵巢上皮癌患者进行回顾性研究。Log-ranktest进行差异性检验,Cox风险比例模型进行预后多因素回归分析。结果早期卵巢上皮癌行腹膜后淋巴结清扫并不能提高生存率（P〉0．05）;晚期卵巢上皮癌行腹膜后淋巴结清扫能提高患者的生存率（P〈0．05）;卵巢上皮癌腹膜后淋巴结清扫组中残余灶〈2cm的生存率高于残余灶≥2cm的患者（P〈0．05）。多因素分析显示：临床期别、残余灶、腹膜后淋巴清扫和化疗疗程是卵巢癌上皮癌的独立预后因素。结论虽然腹膜后淋巴结清扫可以改善卵巢癌患者生存率,但是建议有选择的进行。对残余灶≥2cm的卵巢上皮癌患者,行腹膜后淋巴结清扫是没有意义的。     

Pretreatment neutrophil-to-lymphocyte and platelet-to- lymphocyte ratios do not predict survival in patients with cervical cancer treated with neoadjuvant chemotherapy and radical hysterectomy

Background A few inflammatory markers were studied to evaluate their possible prognostic roles in various cancers.The neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio are hypothesized to reflect the systemic inflammation.The objective of the present study was to investigate whether or not the pretreatment neutrophil-to-lymphocyte ratio or platelet-to-lymphocyte ratio can predict the survival of patients with cervical cancer treated with neoadjuvant chemotherapy and radical hysterectomy.Methods We performed a retrospective study on cervical cancer patients (FIGO stage Ib2-Ⅱb) who had undergone neoadjuvant chemotherapy and radical hysterectomy at Peking Union Medical College Hospital between January 1999 and December 2010.Data on demographics,clinical prognostic markers and histopathology were collected and analyzed.Urivariate and multivariate analyses for prognostic factors were performed.Results A total of 111 patients were identified.The median neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios were 2.4 and 142.2,respectively.Overall survival and progression-free survival were neither significantly different between patients with high and low neutrophil-to-lymphocyte ratio (P=0.149 and P=0.108) nor in high and low platelet-to-lymphocyte ratio (P=0.336 and P=0.510).On multivariate analysis,lymph node status (P=0.000 and P=0.007)and lymphovascular space involvement (P=0.001 and P=0.001) were independent prognostic factors of progression-free survival and overall survival.Conclusions Lymph node status and lymphovascular space involvement were found to be independent prognostic factors for patients with cervical cancer who underwent neoadjuvant chemotherapy and radical hysterectomy.The pretreatment neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios seemed not to predict the survival of patients with cervical cancer treated with neoadjuvant chemotherapy and radical hysterectomy.     

1340例胃癌根治术后患者预后的多因素分析

目的:探讨影响胃癌根治术后患者预后的因素?方法:完整随访2005年1月~2009年12月于南京医科大学第一附属医院行胃癌根治术的1 340例患者(Ⅰ~Ⅲ期),对其临床病理特征和术后辅助化疗等因素进行统计分析?结果:1 340例患者目前存活956例,死亡384例,总体术后1?3?5年累积生存率分别为87%?63%?52%?单因素?多因素分析显示,年龄?肿瘤直径?脉管神经侵犯?浸润深度?区域淋巴结转移数目及TNM分期是胃癌根治术患者的独立预后因素(P < 0.05)?结论:年龄?肿瘤直径?脉管神经侵犯?浸润深度?转移淋巴结数目及TNM分期能为临床判断胃癌预后及选择合理治疗方案提供参考?     

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.