晚期卵巢癌间歇性缩瘤术的临床意义

１９８７年５月至１９９３年５月，我科共收治２４例首次手术未达最佳缩瘤（残瘤＞２ｃｍ）要求的晚期上皮性卵巢癌患者，其中１４例给予化疗２～３疗程后进行了间歇性２次缩瘤术，均达最佳缩瘤之要求，术后残余瘤直径≤２ｃｍ，平均生存时间２２．５６月。未行２次缩瘤术的１０例病人接受联合化疗，平均生存时间为１３．４０月，两者比较差异有显著性（Ｐ＜０．０５）。认为化疗次数是影响预后的因素（Ｐ＜０．０１），而病理类型、病理分级、年龄对生存时间无明显影响。     

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。     

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。     

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<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<0.001; 4.23±0.21 hours: 6.15±0.38 hours, t2=28.92, P2<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>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.     

晚期卵巢癌患者肿瘤减灭术前评估方法的进展

晚期卵巢癌的标准化治疗包括手术及以铂类为主的辅助化学治疗。对于部分晚期卵巢癌患者,初始手术 治疗有时难以彻底切除肿瘤,实现满意的肿瘤减灭术。新辅助化学治疗可以减少肿瘤负荷,提高手术彻底切除肿瘤 的可能性,作为一种补充性的治疗方法已逐渐应用于临床。对于晚期卵巢癌患者,目前有不少术前评估肿瘤减灭术 的方法,比如检测血清肿瘤标志物CA125水平、影像学模型(CT,PETCT,MRI)、腹腔镜探查术等。腹腔镜探查术作 为一种新的肿瘤减灭术前评估方法,值得进一步研究。     

孕激素联合化疗治疗卵巢上皮性癌

目的 分析孕激素联合以铂类为主的常规化疗对卵巢上皮性癌1～4期患者的临床疗效。方法 以已行瘤体减灭术的卵巢上皮性癌患者1～4期为研究对象，分为单纯化疗组、己酸孕酮组和普维拉组。随访、统计各组各期患者的生存率及复发率、血清激素水平、骨密度变化以及化疗副反应。结果 孕激素联合以铂类为主的化疗对早期卵巢上皮性癌的预后无明显影响，但对晚期(3期)卵巢上皮性癌的术后近期以及远期(2～5年)生存率及复发率均有改善趋势。单纯化疗组、己酸孕酮组、普维拉组3期患者术后3年生存率分别为34．8％、66．2％、73．9％，复发率分别为72．2％、47．3％、40．6％；单纯化疗组、己酸孕酮组术后5年生存率分别为17．4％、48．4％，复发率分别为81．5％、62．4％。孕激素的使用不影响患者血清激素水平，也不增加化疗的毒、副作用。联合孕激素治疗的患者术后骨密度下降较一般绝经后妇女慢。结论 孕激素联合以铂类为主的常规化疗可改善晚期卵巢上皮性癌的预后，并且不增加化疗的毒副作用，可改善患者的骨量丢失。     

Ⅲ期卵巢上皮性癌肿瘤细胞减灭术及化疗对预后的影响

目的：评价肿瘤细胞减灭术及化学治疗对Ⅲ期卵巢上皮性癌生存的影响。方法：回顾性分析1999年1月-2005年4月收治的手术病理分期为Ⅲ期的卵巢上皮性癌30例,对其进行肿瘤细胞减灭术及PC方案化疗。结果：30例患者平均年龄52（42—62）岁,其中27例（90％）为浆液性乳头状囊腺癌,3例（10％）为粘液性囊腺癌,所有患者均接受了肿瘤细胞减灭术,其中27例（90％）为理想的肿瘤细胞减灭术,3例（10）为不理想的肿瘤细胞减灭术,其中理想的肿瘤细胞减灭术的平均生存时间30个月,而不理想者仅为18个月,术后化学治疗达到6个疗程者平均生存时间为29个月,而不足6个疗程者仅为12个月。结论：理想的肿瘤细胞减灭术及术后积极的化疗可以改善Ⅲ期卵巢上皮性癌的预后。     

卵巢癌耐药机制与靶向治疗策略的研究进展

手术结合化疗是卵巢上皮性癌的主要治疗手段,其中以R0为目标的卵巢癌肿瘤细胞减灭术结合个体化的化疗方案的应用,使得部分患者5年生存率有了很大的提升.但是晚期患者的耐药与复发仍然是困扰广大临床医师与科研工作者的难题,而化疗耐药因其病因不清、机制复杂,是临床亟待解决的难题和热点.近年来围绕此问题开展的基础与临床相结合的卵巢癌...     

新辅助化疗及间歇性肿瘤细胞减灭术在晚期上皮性卵巢癌中的应用

新辅助化疗及间歇性肿瘤细胞减灭术逐渐成为晚期上皮性卵巢癌治疗的主流模式之一,但其临床应用中仍有很多问题值得商榷.本文对新辅助化疗在晚期卵巢癌患者中的应用价值及争议等问题进行阐述,以期引起广大妇科肿瘤医师的重视和深入思考,并促进新辅助化疗的合理应用和临床研究.     

晚期卵巢癌化疗与减瘤术联合应用

总结１９８９～１９９２年经化疗与肿瘤细胞缩减术（简称减瘤术）治疗２６例Ⅲ、Ⅳ卵巢癌患者的临床资料．结果显示对晚期卵巢癌病人酌情给予术前化疗有利于提高减瘤术的成功率，术后辅助多疗程联合化疗可延长生存期，改善预后．本文对手术与化疗的配合，术前化疗的选择和减瘤术的适应症及残余瘤与生存关系进行了探讨．     

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 >2 cm or those with mucinous adenocarcinoma （P>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<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<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.     

新辅助化疗联合间隔性减灭术在卵巢上皮癌中的研究进展

卵巢上皮癌是恶性度高、进展快、易复发、预后差的常见妇科恶性肿瘤,且卵巢癌在明确诊断时多属晚期,往往手术并不能达到满意的肿瘤细胞减灭术,从而影响预后。近年来由于新辅助化疗(NAC)的应用,使手术切净率大大地提高,因此该文就NAC联合间隔性细胞减灭术的概念,适应人群,评估方法,对预后的影响以及应用前景进行综述。     

紫杉醇联合铂类化疗对晚期卵巢上皮细胞癌患者CD4+CD25+FOXP3+细胞的影响及意义

目的观察紫杉醇联合铂类方案化疗对晚期卵巢上皮细胞癌患者的外周血中CD4+CD25+FOXP3+阳性细胞率的变化,并观察此变化与患者化疗疗效及与CA125等肿瘤标志物的相关性,是否可作为晚期卵巢上皮性癌化疗疗效的预测指标。方法选择36例卵巢上皮性癌患者,均有病理证实,为术后复发或姑息性减瘤术后,应用FACS检测患者化疗前、2周期、4周期、6周期化疗后外周血CD4+CD25+FOXP3+细胞阳性率,同时检测CD4+/CD8+比值。观察终点为出现病情进展,记录无疾病进展时间。结果 CD4+CD25+FOXP3+细胞阳性率在化疗敏感性(CR+PR)患者中下降明显,尤其是PR患者。而在化疗后进展的患者中无明显变化,甚至有上升趋势。CD4+/CD8+比值在化疗敏感性(CR+PR)患者中升高,而在进展患者中无变化,甚至下降。结论晚期卵巢上皮癌患者中外周血中CD4+CD25+FOXP3+细胞阳性率在化疗前后的变化与患者化疗疗效相关,可作为预测化疗疗效的一项预测指标。     

Evaluation of second cytoreductive surgery in the treatment of epithelial ovarian cancer

OBJECTIVE: To evaluate the effectiveness of second cytoreductive surgery in the treatment of epithelial ovarian cancer. METHODS: From January 1989 to June 1994, second cytoreductive surgery was carried out on 33 patients with epithelial ovarian cancer who either underwent unsatisfactory primary debulking operation or had recurrence. According to FIGO staging (1987), there were 5 patients in stage I, 2 in stage II, 25 in stage III, and 1 in stage IV. Pathological grading was G1 in 2 cases, G2 in 9, G3 in 19 and uncertain in 3. The 33 patients can be divided into 3 categories: I, nine patients who had unsatisfactory primary debulking operation with macroscopic residual > 2 cm, and 1-2 courses of postoperative chemotherapy; II, 15 patients who had 6-8 courses of cisplatin-based postoperative chemotherapy and in whom recurrence was diagnosed after complete response for at least 3 months; and III, 9 patients who had the same treatment as category II and survived without cancer clinically for more than 6 months, and in whom recurrence was diagnosed during second-look laparotomy. All patients had been followed up for at least two years (27-168 months) dated from the primary debulking operation. RESULTS: Fifteen cases had no macroscopic residuals (group A), 5 had residuals < 2 cm (group B), and 13 had residuals > 2 cm (group C). The medium survival time and two-year survival rate in groups A, B and C were 59.09, 20.6 and 8.29 months, and 93.3%, 20% and 7.69% respectively (P < 0.001, A vs C; P < 0.05, A vs B and B vs C). CONCLUSIONS: The results suggest that second cytoreductive surgery is of value, and the key to success is to eliminate any macroscopic residual focus, or at most, to leave only minimal residuals < 2 cm. It is suggested that well-targeted multiple-route chemotherapy with sufficient courses before second cytoreductive surgery is important to achieving better results.     

新辅助化疗治疗晚期卵巢癌的临床疗效评价

  目的：对新辅助化疗治疗Ⅲ~Ⅳ期晚期卵巢癌的疗效进行评价。方法：回顾性分析204例晚期卵巢癌患者的诊治情况。2003年之前收治的99例Ⅲ~Ⅳ期卵巢癌患者为A组,行一期手术治疗。2003年之后收治的105例Ⅲ~Ⅳ期卵巢癌患者为B组,其中有39例在进行1~3疗程新辅助化疗的基础上行肿瘤细胞减灭术,为B1组,另66例行一期手术治疗,为B2组。入组患者术后均行6~8疗程卡铂、环磷酰胺联合干扰素的化疗。结果：B1组患者围手术期一般状况优于B2组（P0.05）。B组患者三年生存率高于A组（P0.05）。结论：对Ⅲ~Ⅳ期的晚期卵巢癌患者而言,有选择性的应用新辅助化疗可以提高其手术满意率、围手术期一般状况以及三年生存率。满意的肿瘤细胞减灭术即残留病灶<2cm可以提高晚期卵巢癌患者的生存率。     

老年卵巢癌术后腹腔热灌注化疗的毒副作用分析

目的探讨腹腔热灌注化疗联合全身静脉化疗在老年上皮性卵巢癌术后辅助治疗的毒副作用。方法 25例老年上皮性卵巢癌患者,分别采用腹腔热灌注化疗+全身静脉化疗(IP组)和单纯全身静脉化疗(IV组),比较两组治疗后的毒副作用。结果两组恶心、呕吐的程度比较,差异有统计学意义(P=0.036);两组血液学毒性、肝肾功能损害、周围神经毒性、腹痛、心脏毒性和发热的程度比较,差异均无统计学意义(P>0.05)。结论腹腔热灌注化疗联合全身静脉化疗作为Ⅱ期以上的老年上皮性卵巢癌术后的一种辅助治疗方法,未增加毒副作用,耐受性好。     

High dose cisplatin compared with high dose cyclophosphamide in the management of advanced epithelial ovarian cancer (FIGO stages III and IV): report from the North Thames Cooperative Group

A randomised study comparing cisplatin 120 mg intravenously with cyclophosphamide 2 g intravenously, each drug being given every month for six months followed by a low dose regimen for a further six months in responding patients, was carried out in 86 patients with advanced epithelial ovarian carcinoma (FIGO stages III and IV). Patients given cisplatin were found to have a longer median survival time than those given cyclophosphamide (19 months compared with 12 months) and a longer median duration of complete clinical response (18 months compared with eight months). The difference in disease free survival was statistically significant even after factors such as age, stage of disease, and the completeness of initial surgery had been taken into account. This study suggests that cisplatin is a more effective chemotherapeutic agent than cyclophosphamide for advanced ovarian cancer and should be the agent of choice in future trials comparing combination chemotherapy with a single agent.     

664例上皮性卵巢癌的临床病理分析

目的 探讨上皮性卵巢癌（EOC）患者临床病理特点,并对影响预后的高危因素进行分析。方法 回顾性分析2006年1月至2011年6月间在我院接受手术治疗的710例EOC患者的临床资料,对其临床病理特点进行总结,单因素及多因素分析影响预后的高危因素。结果 将664例资料完整的EOC患者纳入研究。患者年龄（49.35±11.58）岁（15～84岁）,其中40岁以上患者占79.07%（525/664）;术前550例患者进行了CA125检测,其中升高者占82.55%（454/550）;浆液性癌占55.57%,黏液性癌占7.68%,子宫内膜样癌占10.09%,透明细胞癌占12.35%;组织分化为G2~G3者占89.61%;FIGO Ⅰ期占30.72%,Ⅱ~Ⅳ期占69.28%;有483例患者接受了腹膜后淋巴结切除术,其中淋巴结转移者占32.71%。平均随访（37.48±12.51）月,664例患者中有126例复发,复发平均时间（26.10±5.75）月;303例死亡,占46.08%,平均存活时间（28.54±9.56）月,其中287例为癌症相关性死亡;存活的361例患者中,无瘤生存者占81.72%,带瘤生存者占18.28%。单因素分析显示EOC患者的预后与发病年龄、FIGO分期、淋巴结转移、缩瘤满意程度、术前CA125水平、病理类型、组织分化及发病模式等因素均有关（P均=0.000）;将患者年龄、FIGO分期、缩瘤满意程度、病理类型、组织分化、发病模式等因素进行多因素分析,结果显示除组织分化以外,其余5项均与患者预后有关;术前CA125升高患者缩瘤满意程度差于CA125正常者（P=0.001）。Log-rank分析显示FIGO分期晚、高级别组织分化、缩瘤不满意、淋巴结有转移以及Ⅱ型卵巢癌等均对生存情况有不良影响。结论 EOC患者发病年龄大、发现时多为晚期,预后差。患者年龄、FIGO分期、缩瘤满意程度、病理类型与患者预后有关。     

腹膜后淋巴结切除术对卵巢恶性生殖细胞肿瘤的治疗意义

目的探讨腹膜后淋巴结切除术在初治及复发卵巢恶性生殖细胞肿瘤(OGCT)患者中对肿瘤复发及患者生存的影响.方法回顾性分析我院1980年6月～2003年6月收治的OGCT患者102例,记录初治及复发手术时进行腹膜后淋巴结切除的情况、病理及其他可能与预后相关的因素.采用cox回归进行与肿瘤复发相关的单因素和多因素分析.结果在初治及复发病例中,腹膜后淋巴结转移与疾病预后无显著相关性.初治时肿瘤FIGO分期、化疗方案、手术彻底性和是否行腹膜后淋巴结切除术是影响疾病复发的显著性因素,其中化疗方案的影响最大.对化疗方案分层后,在博莱霉素 足叶乙甙 顺铂(BEP)或顺铂 长春新碱 博莱霉素(PVB)方案化疗时,是否行腹膜后淋巴结切除术与肿瘤复发无显著相关性,而在其他方案化疗组及未化疗者中,行腹膜后淋巴结切除术显著减少复发.在复发病例中仅手术彻底性与复发后生存时间相关,复发手术是否行腹膜后淋巴结切除术与复发后生存期无显著相关性.结论腹膜后淋巴结转移与OGCT的预后无明确的负相关性,对已进行手术而未行腹膜后淋巴结切除者,如已开始化疗,无须再次手术,可根据初次手术的结果行BEP或PVB方案规范化疗;对于初治患者,如有足够熟练的手术技巧,在尽量进行肿瘤细胞减灭的同时,应行该术式;对于复发患者,手术的目的是进行满意的肿瘤细胞减灭,腹膜后淋巴结切除意义有限.     

泰素加卡铂方案治疗晚期与复发性上皮性卵巢癌

为评价泰素加卡铂联合化疗治疗晚期与复发性上皮性卵巢癌的疗效，对23例采用泰素加卡铂治疗患者的疗效进行分析。14例初治晚期患者采用泰素加卡铂方案一线化疗，有效12例，完全缓解12例，2年无瘤存活者10例，9例复发患者采用泰素加卡铂方案二线化疗，有效4例，完全缓解2例，部分缓解2例，该方案主要副反应为骨髓抑制和关节肌肉痛，提示；泰素加卡铂方案可作为治疗晚期上皮性卵巢癌的首选一线方案。