新辅助化疗在晚期卵巢上皮性癌综合治疗中的临床研究

目的探讨新辅助化疗(NACT)在晚期卵巢上皮性癌(卵巢癌)治疗中的临床意义。方法回顾性分析四川省肿瘤医院1999年1月至2008年12月收治的晚期卵巢癌(FIGOⅢ、Ⅳ期)患者161例,其中73例接受新辅助化疗+手术治疗+化疗(研究组),88例行初次肿瘤细胞减灭术+化疗(传统组)。结果研究组肿瘤手术切除率(即理想减瘤率)77.1%,传统组为56.8%,差异有统计学意义(P=0.012)。研究组术中失血量、术中输血量、术中补液量、腹水量和手术时间与传统组比较,差异均有统计学意义(P<0.05)。研究组平均无进展生存期(PFS)和总体生存期(OS)分别为22.7(7～63.5)个月和33.5(13.8～92.3)个月,传统组分别为21.7(4.3～61.2)个月和32.1(12.4～114.9)个月,两组比较差异无统计学意义(分别为P=0.082和P=0.293)。研究组和传统组5年生存率分别为17.8%和11.4%,差异无统计学意义(P=0.503)。结论行新辅助化疗+手术治疗+化疗治疗晚期卵巢上皮性癌的PFS、OS与仅行初次肿瘤细胞减灭术+化疗相似,但前者能明显提高肿瘤的手术切除率、减少术中出血量,同时并没有增加手术的并发症。     

卵巢上皮性癌手术加铂类药物联合化疗疗效的相关临床病理因素分析

目的:探讨影响卵巢上皮性癌手术加铂类药物联合化疗疗效的相关临床病理因素。方法:回顾性分析534例初治行手术加铂类药物联合化疗的卵巢上皮性癌患者,并随访预后。用Logrank test检验及Cox模型作临床病理相关因素分析。结果:1手术病理分期Ⅰ、Ⅱ期患者的中位总生存期(OS)及中位无进展生存期(PFS)高于Ⅲ、Ⅳ期,Ⅲ期患者的中位OS及中位PFS高于Ⅳ期(P0.05)。2组织学分级高分化癌患者中位OS及中位PFS均高于中、低分化患者(P0.01)。3达理想肿瘤细胞减灭患者中位OS及中位PFS显著高于肿瘤细胞减灭不理想患者(P0.01)。4不管是否达到理想减瘤,大网膜切除者中位OS及中位PFS高于大网膜未切除者(P0.05)。5达到理想减瘤患者中,腹膜后淋巴结未转移者中位OS及中位PFS高于淋巴结转移者(P0.01),肠管受累未切除者中位OS及中位PFS高于肠管切除者(P0.05),横膈未受累患者的中位OS及中位PFS高于横膈受累者(P0.05)。6化疗方案TC及TP有相似的疗效,但两组化疗方案的中位OS及中位PFS均高于PC化疗组,化疗疗程6次组其中位OS及中位PFS低于化疗疗程≥6次组,差异均有统计学意义(P0.05)。7经Cox模型多因素分析,手术病理分期、组织学分级、肿瘤细胞减瘤理想程度、大网膜切除是影响手术疗效的独立因素(P0.01)。结论:影响卵巢上皮性癌患者手术加铂类药物联合化疗预后决定于组织学分级、手术病理分期、大网膜切除、肿瘤细胞减瘤理想程度。在大的诊治原则下,根据患者的具体病情尽量做到个体化治疗。     

46例原发性女性生殖道恶性黑色素瘤的预后分析及PD-1单抗疗效初步评估

目的:分析生殖道恶性黑色素瘤患者的预后相关因素及PD-1单抗疗效评估。方法:回顾分析2005年10月～2022年7月云南省肿瘤医院收治的46例女性生殖道恶性黑色素瘤患者的临床特征及生存状况。结果:外阴黑色素瘤的5年生存率为57.1%,Ⅰ期、Ⅱ期患者的总生存期(OS)明显长于Ⅲ/Ⅳ期(78.5个月、未达到vs 15.0个月,P=0.003),术后使用辅助治疗的中位无复发生存时间(RFS)显著长于未辅助治疗组(50.9个月vs 5.3个月,P=0.003);阴道宫颈黑色素瘤的3年生存率为38.9%,阴道黑色素瘤局切组中位RFS及OS均低于根治组(RFS:4.5个月vs 11.0个月,P=0.073;OS:23.6个月vs 29.5个月,P=0.695);晚期女性生殖道黑色素瘤免疫治疗组中位RFS较未免疫治疗组延长(8.2个月vs 3.5个月,P=0.063),免疫治疗组中位OS未达到,未免疫治疗组中位OS为8.5个月,差异无统计学意义(P=0.320)。结论:外阴黑色素瘤预后最好,分期越晚,预后越差;Ⅰ、Ⅱ期外阴黑色素瘤术后加用辅助治疗可延长患者的无瘤生存期;肿瘤局限于阴道壁的阴道黑色素瘤...     

晚期卵巢上皮癌耐药分析及复发后治疗

目的:分析晚期卵巢上皮癌的耐药情况及复发后治疗,探讨化疗敏感性对预后的影响。方法:按初治后的无瘤间期(disease free interval,DFI)将176例患者分为R组(铂耐药,DFI<6个月)和S组(铂敏感,DFI>6个月)两组,S组再分为S1组(铂部分敏感,DFI为6～12个月)和S2组(铂敏感,DFI>12个月)两组,分析各组患者的临床特征、复发情况、复发后治疗及预后。结果:176例晚期卵巢上皮癌,平均发病年龄54.01±10.19(23～77)岁,69.3%为浆液性,71.6%为低分化,淋巴转移率42.8%,30.1%原发耐药,总5年生存率45.4%,中位OS为56个月,中位PFS为24个月。R组(铂耐药)和S2组(铂敏感)的中位OS和PFS有显著差异,S1组的中位OS及中位PFS分别为40和17个月,介于铂耐药、铂敏感之间。S1组的肿瘤、术前CA125、盆腔腹主动脉旁淋巴结转移率也介于铂耐药以及铂敏感患者之间,其初次手术达满意肿瘤减灭的比例为13.8%,显著低于铂敏感者(29.8%)(P=0.047)。铂部分敏感患者复发后,更换化疗方案者中位OS较继续使用TC/TP或CAP化疗者略长,但无统计学意义(P=0.081)。结论:将铂部分敏感患者单独分类有意义,此类患者复发后的治疗措施尚无定论,有待进一步研究。     

244例卵巢上皮癌铂耐药情况及其对预后的影响

目的:分析卵巢上皮癌对铂类为基础的联合一线化疗的耐药情况,探讨初治化疗敏感性对预后的影响。方法:按初治后无瘤间期(DFI)长短将患者分为铂耐药、铂部分敏感、铂敏感3组,比较各组患者的临床特征、复发治疗及预后情况。结果:244例患者的中位发病年龄52岁,晚期占72.1%,61.1%为浆液性,67.2%为低分化,淋巴转移率31.2%,原发耐药比率23.36%,总5年生存率54.7%,中位总生存时间(OS)为70个月,中位无疾病进展时间(PFS)为29个月。晚期、未达到满意肿瘤细胞减灭术的患者铂耐药几率增高(P0.001,P0.001)。铂耐药患者的CA125及淋巴转移率高于铂敏感组(P=0.03,P=0.003)。3组患者中任意两组的OS及PFS均有显著差异(P0.001)。部分敏感患者复发后,更换化疗方案者中位OS较继续TC(TP)或CAP化疗者略长(P=0.196)。结论:中低分化的晚期患者,CA125超过1000U/ml,未达到满意肿瘤细胞减灭术,盆腔、腹主动脉旁淋巴结阳性,耐药或部分敏感的几率高,预后差。化疗敏感性不同的患者预后不同,复发后应选择不同的化疗方案。     

新辅助化疗对晚期卵巢癌治疗应用价值的评估及多因素分析

目的:对晚期卵巢癌患者采用新辅助化疗的应用价值进行评估,及探讨新辅助化疗后间歇性肿瘤细胞减灭术满意缩瘤的标准。方法:回顾性研究2005年1月1日至2010年12月31日在四川大学华西第二医院住院治疗的晚期卵巢癌患者339例。比较225例接受初始肿瘤细胞减灭术及术后行辅助化疗(PDS组)和114例新辅助化疗联合间歇性肿瘤细胞减灭术(IDS组)患者的手术、围手术期并发症、无进展生存期(PFS)及总生存期(OS)。采用单因素和多因素分析晚期卵巢癌患者预后的独立因素,以及独立因素与晚期卵巢癌患者的临床及病理学特征与治疗方案选择间的关系。结果:1两组患者肿瘤细胞减灭术达到满意缩瘤的几率比较,差异无统计学意义(P0.05)。但IDS组肿瘤细胞减灭术达到无肉眼残留病灶比例(39.47%)高于PDS组(27.56%)(P0.05)。2IDS组术中出血量更少、输血比例更小、手术范围更小、手术时间更短、住院时间更短,差异有统计学意义(P0.05)。3两组的PFS和OS比较差异无统计学意义(P0.05)。多变量Cox回归分析结果患者肿瘤细胞减灭术后残留病灶大小(P0.001)、FIGO分期(P0.001)和年龄(P=0.003)是影响晚期卵巢癌患者OS的独立因素。4IDS组术后仅无肉眼残留病灶可提高患者的OS。FIGO分期与治疗方案选择间的关系有统计学意义(P=0.01),最大原发肿瘤直径与Ⅳ期卵巢癌患者治疗方案选择间的关系有统计学意义(P=0.07),通过STEPP分析,原发肿瘤直径的界值为8.6 cm。结论:新辅助化疗可以提高肿瘤细胞减灭术达到无肉眼残留的几率,缩小手术范围,减少围手术期并发症的发生,但不能提高患者的PFS和OS。新辅助化疗后间歇性肿瘤细胞减灭术中满意缩瘤的标准应为无肉眼残留病灶。患者的FIGO分期和最大原发肿瘤直径可能对晚期卵巢癌患者选择治疗方案提供帮助。     

甲磺酸阿帕替尼联合化疗治疗宫颈癌肺转移患者的疗效评估

目的:探讨甲磺酸阿帕替尼联合化疗治疗宫颈癌肺转移患者的疗效及安全性,以及联合治疗疗效的相关影响因素及预后评估,为临床决策提供新思路。方法:回顾分析2015年1月至2019年7月于山东省肿瘤医院妇瘤科接受阿帕替尼联合化疗治疗宫颈鳞癌伴肺转移患者19例。分别采用RE-CIST1.1版与NCICTCAE 4.0版标准评价近期疗效和不良反应。采用Kaplan-Meier法进行生存分析。结果:无完全缓解病例(CR),13例部分缓解(PR),3例稳定(SD),3例部分进展(PD),客观缓解率(ORR)为68.4%,疾病控制率(DCR)为84.2%。中位PFS为5个月(95%CI为3.055～6.945个月),中位OS为13个月(95%CI为11.95～14.05个月),1年生存率为63.2%,2年生存率为15.8%。初始治疗分期Ⅱb～Ⅳ期患者中位PFS为5个月,中位OS为13个月;Ⅰa～Ⅱa2期患者中位PFS为6个月,中位OS为15个月,两组PFS及OS均无统计学差异(P0.05)。单纯肺转移患者中位PFS为5.5个月,中位OS为17.3个月;合并其他部位转移患者中位PFS为4个月,中位OS为13个月,两组PFS及OS均无统计学差异(P0.05)。年龄60岁及以上患者中位PFS为5个月,中位OS为10个月;年龄60岁以下患者中位PFS为5个月,中位OS为13.5个月;两组PFS及OS均无统计学差异(P0.05)。常见不良反应包括高血压、蛋白尿、骨髓抑制、手足综合征、乏力。结论:甲磺酸阿帕替尼联合化疗对于宫颈癌肺转移患者有着较好的疾病控制率和安全性。患者初始治疗分期、是否合并肺外脏器转移及年龄因素与患者预后无关。     

安罗替尼联合化疗在子宫颈癌进展期患者中的疗效与安全性观察

目的:探讨子宫颈癌同步放化疗后进展期患者二线及二线以上应用安罗替尼的疗效与安全性。方法:回顾性分析一线治疗失败的复发转移的子宫颈癌患者作为研究对象,共入组43例患者,单用组(n=13)患者接受安罗替尼单药治疗,联合组(n=15)安罗替尼联合化疗,化疗组(n=15)患者接受单纯化疗。收集患者基线资料、治疗前后影像学改变及治疗相关不良事件,分析探讨患者近期疗效、远期疗效及不良反应。结果:截止末次随访,无一例患者失访,3组患者疾病控制率(DCR)差异有统计学意义(P=0.009),与对照组相比,联合组DCR显著受益(93.33%vs 40.00%,P=0.005)且中位无进展生存期(PFS)明显延长(8.5个月vs 4.0个月; HR 0.29,95%CI 0.12～0.69,P <0.001),联合组较单用组中位PFS也显著延长(8.5个月vs 4.6个月; HR 0.45,95%CI 0.18～1.10,P=0.037)。最常见的不良反应为1级和2级,包括高血压、贫血和乏力,3级不良反应为高血压(单用组1例,联合组2例)和贫血(联合组2例),无更高级别不良反应发生。3组患者不良反应发生率差异无统计学意义(P>0.05)。结论:安罗替尼联合化疗治疗进展期子宫颈癌患者安全有效,患者耐受性良好。     

新辅助化疗联合间隔肿瘤细胞减灭术对晚期卵巢癌耐药性和生存时间的影响及耐药性影响因素分析

目的:分析新辅助化疗联合间隔肿瘤细胞减灭术(NACT-IDS)和初次肿瘤细胞减灭术(PDS)两种方法在治疗晚期上皮性卵巢癌时对其耐药性和生存时间的影响,并分析铂类耐药性的影响因素。方法:回顾性分析2008年1月至2014年6月就诊我院的354例晚期(FIGOⅢC~Ⅳ期)上皮性卵巢癌患者。根据治疗方法不同分为NACT-IDS组173例和PDS组181例,术后均辅以铂类药物化疗。全部治疗结束后,比较NACT-IDS组及PDS组患者对铂类药物的敏感性,并通过Logistic回归对铂类耐药的单因素、多因素影响进行分析,利用Kplan-Meier方法进行生存分析。结果:至随访结束,PDS组有149例(82.3%)复发,NACT-IDS组有132例(76.3%)复发,两组比较差异无统计学意义(P=0.162)。铂类耐药患者PDS组有26例(14.3%),NACT-IDS组有42例(24.3%),两组比较差异有统计学意义(P=0.018)。对铂类耐药性作单因素分析发现治疗方法、FIGO分期、总化疗周期与铂耐药性有关(P0.05)。而多因素分析发现新辅助化疗不是影响铂耐药性的独立危险因素。NACT-IDS组与PDS组中位无病生存期(DFS)(13.5月vs 15.4月,P=0.475)、总生存期(OS)(51.7月vs 46.2月,P=0.147)比较,差异均无统计学意义。结论:NACT-IDS治疗晚期卵巢癌时增加了对铂类药物的耐药性,但对生存时间无明显影响。新辅助化疗不是铂类耐药性的独立危险因素。     

两种人乳头瘤病毒检测方法对宫颈液基细胞学ASC-US分流作用比较

目的探讨外周血纤维蛋白原与白蛋白比值(FAR)评估卵巢癌预后的价值。方法收集2013年1月至2019年12月本院110例良性卵巢及59例行初始全面分期手术的卵巢癌患者的临床病理资料进行回顾性分析,根据ROC曲线确定FAR在卵巢良恶性肿瘤、卵巢癌复发与否最佳临界值,分析术前FAR对卵巢癌患者生存预后的影响。结果 59例卵巢癌患者中位随访时间56个月(9～90个月),17例复发,59例患者中位无进展生存期(PFS)45个月(4～90个月)。外周血FAR的水平在卵巢癌中高于卵巢良性肿瘤(P 0.05),在卵巢癌组术后复发者高于未复发者(P 0.05)。根据ROC曲线,FAR分别取0.071、0.101作为卵巢癌良恶性肿瘤、卵巢癌术后复发的最佳临界值。单因素分析显示,FAR≥0.101、FIGO分期(Ⅲ～Ⅳ期)、CA125≥35 U/L、分化低、腹水是影响患者手术后5年PFS的危险因素(P 0.05),FAR≥0.101、FIGO分期(Ⅲ～Ⅳ期)、CA125≥35 U/L、分化低是5年总生存期(OS)的危险因素(P 0.05)。多因素分析显示,FIGO分期(Ⅲ～Ⅳ期)是卵巢癌患者5年PFS的独立危险因素(P 0.05)。结论外周血FAR检测方便,对卵巢癌的预后有一定的评估价值。     

The prognostic significance of the immunohistochemical expression of p53, bcl-2, c-erb B-2 and cathepsin-D in ovarian cancer patients receiving platinum with cyclophosphamide or paclitaxel chemotherapy

PURPOSE: To evaluate the prognostic significance of the immunohistochemical expression of p53, bcl-2, c-erbB-2 and cathepsin-D in epithelial ovarian cancer (EOC). METHODS: We analyzed 100 patients with ovarian carcinoma, FIGO Stage IC-IV who underwent primary cytoreductive surgery and received adjuvant chemotherapy with cyclophosphamide and a platinum analogue (CP) (n = 46) or paclitaxel and a platinum analogue (TP) (n = 54). Immunohistochemical expression was studied on paraffin-embedded tissue from the primary tumor. RESULTS: After a median follow-up of 55 months median progression-free survival (PFS) and overall survival (OS) were 16 and 41 months, respectively. Positive bcl-2 staining and absence of cathepsin-D expression were associated with an increased complete response rate in the CP group (p = 0.011 and p = 0.003) but not in the TP group. PFS and OS were not associated with the expression of any of the markers studied. FIGO stage (p = 0.006) and histology (p = 0.047) were the only independent prognostic factors for survival. CONCLUSION: Bcl-2 and cathepsin D expression are associated with response to CP but not TP chemotherapy. P53, bcl-2, c-erb B-2 and cathepsin D expression was not correlated with PFS and OS in our study.     

Neoadjuvant chemotherapy and interval debulking for advanced epithelial ovarian cancer

A retrospective matched-control study was conducted to review our experience with FIGO stage III and IV epithelial ovarian cancer in patients referred after initial laparotomy and biopsy only. The study group comprised 22 patients; planned treatment was two to four cycles of chemotherapy, interval debulking surgery, six more chemotherapy cycles, and second-look laparotomy. Two control groups were matched with the study group according to FIGO stage, histologic type, and grade (2 or 3) and patient age +/- 5 years. The first control group (22 patients) had greater than 2 cm residual disease after initial surgery; their planned treatment was a minimum of six cycles of chemotherapy plus second-look laparotomy. The second control group (18 patients) was referred after initial laparotomy and biopsy only; their disease was immediately reexplored and debulked. Subsequent planned treatment was a minimum of six cycles of chemotherapy plus second-look laparotomy. All patients received cisplatin-based chemotherapy. Optimal cytoreduction to less than or equal to 2 cm was achieved for 77% of the study group vs 39% of the immediate-reexploration group (P = 0.02). Median survival times for the three groups were not different (16 vs 19.3 vs 18 months, respectively) (P = 0.58). Within the study group, patients who were optimally debulked survived significantly longer than those who were not (18.1 vs 7.5 months) (P = 0.02). Morbidity of the interval debulking procedure was acceptable. Study findings suggest that patients with bulky residual disease have a uniformly poor prognosis regardless of the timing of further surgery.     

Twelve-year follow-up of a randomized trial comparing cisplatin and cyclophosphamide with cisplatin, doxorubicin and cyclophosphamide in patients with advanced epithelial ovarian cancer

From 1982 to 1984, 131 patients with FIGO stage Ic-IV epithelial ovarian cancer were included in a randomized clinical trial comparing cisplatin 50 mg m⁻² plus cyclophosphamide 600 mg m⁻² (PC regimen) with PC plus doxorubicin 45 mg m⁻² (PAC regimen). Chemotherapy was repeated every 4 weeks for six cycles. The criteria for entry, the characteristics of the elegible patients, the response rates and the toxicities have been previously reported. The study was updated in August 1994 with a median follow-up of 10.5 years (range 10–12 years). In the whole series, the median time to progression is 13 months and the 12-year progression-free survival (PFS) is 18%, whereas the median time to survival is 21 months and the 12-year survival is 21%. By log-rank test survival is significantly related to residual disease after first surgery ( P <0.0001), ECOG performance status (PS) ( P <0.0001), FIGO stage ( P =0.0001) and histologic grade ( P =0.04), but not to type of chemotherapy and age. By Cox proportional hazard model residual disease ( P =0.0004), histologic grade ( P =0.01) and ECOG performance status ( P =0.049), but not FIGO stage, treatment arm and age, are independent prognostic variables for survival. The survival curves are superimposable in the two treatment arms among patients with residual disease <2 cm, whereas there is a trend in favor of the PAC regimen among patients with larger residual disease. By log-rank test PFS is not significantly related to chemotherapy arm. However, it is worth noting that among patients with residual disease >2 cm 12-year PFS is 12.5% for PAC arm, while all patients of PC arm progressed by the sixth year. Conversely, the PFS curves are superimposable in the two treatment arms among patients with residual disease <2 cm.     

Treatment of FIGO stage IV ovarian carcinoma: results of primary surgery or interval surgery after neoadjuvant chemotherapy: a retrospective study

The objective of the study is to determine whether surgery influences the outcome of stage IV ovarian cancer. The study design is as follows: From May 1995 to December 2000, 129 patients with FIGO stage IV ovarian cancer, recruited in 42 centers, were prospectively included in GINECO first-line randomized studies of platinum-based regimens with paclitaxel administered simultaneously or sequentially. In all, 109 were eligible for this study. Standard peritoneal cytoreductive surgery was defined as a procedure including at least total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and peritoneal debulking. Surgery was considered optimal if residual lesions were smaller than 1 cm. The Kaplan-Meier method was used to compare survival. Initial abdominopelvic cytoreductive surgery was considered standard in 55 (54%) patients. Abdominopelvic surgery was optimal in 29 patients and nonoptimal in 26. Twenty-two (22%) patients had a simple biopsy, and 25 (24%) patients underwent substandard surgery. Twenty-two of these 47 patients without initial standard surgery underwent a second surgical procedure, and 17 of the 22 patients completed standard surgery. The median overall survival time in the entire population was 24.3 months (95% confidence interval [CI], 19.5-29.1 months). Patients treated without a cytoreductive surgical procedure had significantly worse median survival (15.1 months; 95% CI, 5.4-24.9 months) than patients who had optimal primary surgery (22.9 months; 95% CI, 15.6-30.1 months), nonoptimal primary surgery (27.1 months; 95% CI, 21.2-32.9 months), or neoadjuvant chemotherapy followed by surgery (45.5 months; 95% CI, 23.5-67.5 months) (P= .001). In conclusion, this study shows a significant benefit of debulking surgery in stage IV ovarian cancer patients who responded to neoadjuvant chemotherapy. Neoadjuvant chemotherapy can help to select patients for surgery.     

Analysis of treatment failures and survival of patients with fallopian tube carcinoma: a cooperation task force (CTF) study

OBJECTIVE: The objective of this retrospective multicenter study was to assess the pattern of failures and survival of patients with primary carcinoma of the fallopian tube. METHODS: The hospital records of 88 patients with primary carcinoma of the fallopian tube were reviewed. Surgery was the initial therapy for all patients. Tumor stage was I in 21 (23.9%), II in 21 (23.9%), III in 43 (48.8%), and IV in 3 (3.4%) patients. Postoperative treatment was given without well-defined protocols. The median follow-up of survivors was 55 months (range, 7-182). RESULTS: Of the 21 patients with stage I disease, 10 had no postoperative treatment and 11 had platinum-based chemotherapy. Five (23.8%) patients recurred after a median of 29 months (range, 8-93) from initial surgery. Of the 21 patients with stage II disease, 2 had no postoperative treatment, 2 underwent external pelvic irradiation, 16 received platinum-based chemotherapy, and 1 patient had oral melphalan. Eight (38.1%) patients recurred after a median of 25.5 months (range, 7-57). Of the 46 patients with stage III-IV disease, 1 patient refused chemotherapy and died after 19 months and 45 patients received platinum-based chemotherapy. A clinical complete response was obtained in 29 (64.4%) patients and a partial response in 8 (17.8%). A second-look laparotomy was performed in 14 of the 29 clinically complete responders: 12 patients were found to be in pathological complete response and 2 had persistent disease. Six (50.0%) of the former recurred after a median of 22 months (range, 13-101) from initial surgery. The two patients with persistent disease developed tumor progression after 15 and 11 months, respectively. Fifteen clinically complete responders did not undergo second-look, and 7 (46.7%) of them had a recurrence after a median of 18 months (range, 9-41). For the whole series, 5-year survival was 57%. By log-rank test, survival was related to FIGO stage (III-IV vs I-II, P = 0.0001), tumor grade (G3 vs G1 + G2, P = 0.0038), and patient age (>58.5 years vs <58.5 years, P = 0.0069), but not to histological type. The Cox model showed that FIGO stage (P = 0.0018) and patient age (P = 0.0290) were independent prognostic variables for survival. Among the patients with stage III-IV disease, 5-year survival was 55% for the patients who had residual tumor <1 cm compared with 21% for those who had larger residuum (P = 0.0169). CONCLUSIONS: Primary carcinoma of the fallopian tube shares several biological and clinical features with ovarian carcinoma. However, when compared with the latter, fallopian tube carcinoma more often tends to recur in retroperitoneal nodes and distant sites. Stage, patient age, and, among patients with advanced disease, residual tumor after initial surgery represent important prognostic variables for survival.     

A retrospective analysis of neoadjuvant platinum-based chemotherapy versus up-front surgery in advanced ovarian cancer

Abstract.   Steed H, Oza AM, Murphy J, Laframboise S, Lockwood G, De Petrillo D, Sturgeon J, Rosen B. A retrospective analysis of neoadjuvant platinum-based chemotherapy versus up-front surgery in advanced ovarian cancer. Int J Gynecol Cancer 2006; 16(Suppl. 1): 47–53.
The objective of this study is to compare progression-free survival (PFS) and overall survival (OS) of ovarian cancer patients treated with neoadjuvant chemotherapy and surgery to primary surgery and postoperative chemotherapy. Retrospective analysis from 1998 to 2003 of 116 patients with ovarian cancer was performed. Fifty women diagnosed by positive cytology received three cycles of carboplatin and paclitaxel. Thirty-six patients subsequently underwent cytoreductive surgery and completed three further cycles postoperatively. The OS and PFS were compared in 66 women treated with primary surgery and postoperative chemotherapy. A statistically significant difference was observed for OS ( P = 0.03, HR = 1.85, CI = 1.06–3.23) and PFS ( P = 0.04, HR = 1.61, CI = 1.03–2.53) favoring the primary surgery group. Due to the small numbers, age, grade, stage, pleural effusions, and histologic cell type were controlled for separately in the bivariate analyses. Controlling for stage made the results weaker. A matched subgroup survival analysis was performed on patients who had surgery following neoadjuvant chemotherapy. After matching for stage and grade and controlling age and pleural effusions ( N = 28 matched pairs), there was no statistical difference for OS ( P = 0.95, HR = 1.04, CI = 0.33–3.30) or PFS ( P = 0.79, HR = 1.11, CI = 0.98–1.04). It is concluded that primary surgery should be considered in all patients. Neoadjuvant chemotherapy may be an alternative in a subset of women with the intent to also perform interval debulking.     

卵巢上皮性癌血清肿瘤标志物谱变化的临床意义

目的 探讨卵巢上皮性癌(卵巢癌)患者化疗后肿瘤标志物谱的变化及其潜在的临床意义.方法 选择1999年1月至2007年7月期间经肿瘤细胞减灭术及规范化疗的卵巢癌患者102例,对其术前、术后、每次化疗前、随访期间和复发前后的血清肿瘤标志物CA125、CA19-9和CP2的水平进行检测、分析,其中48例患者的肿瘤标志物记录完整而纳入分析,复发患者为28例,初治化疗患者20例(均为耐药病例).根据肿瘤标志物谱变化与否,分别将复发和初治化疗患者分为肿瘤标志物谱变化组与未变化组.平均随访时间为25个月.结果 (1)肿瘤标志物谱的主要变化表现为标志物的数最变化和(或)标志物的种类改变.28例复发患者中肿瘤标志物谱发生变化者占46%(13/28),20例初治化疗患者中标志物谱发生变化者占45%(9/20).(2)肿瘤标志物谱变化的复发患者中,病理类型以浆液性癌所占比例最高,为77%(10/13),而初治化疗患者中,以黏液性癌所占比例最高,为4/9.(3)复发患者肿瘤标志物谱变化组的无疾病进展期和中位总生存时间分别为22.2、60.0个月,较未变化组(分别为17.4、46.0个月)明显延长(P均<0.05);初治化疗患者肿瘤标志物谱变化组的中位总生存时间较未变化组(分别为15.9、25.0个月)明显缩短(P<0.05).结论 卵巢癌化疗期间和复发后肿瘤标志物谱可发生变化,化疗及随访期间应对肿瘤标志物进行联合检测.     

Ⅳ期卵巢上皮性癌的治疗及预后影响因素

目的　评价肿瘤细胞减灭术及化学治疗对Ⅳ期卵巢上皮性癌生存的影响。方法　复习 1982年 1月至 1997年 12月间收治的Ⅳ期卵巢上皮性癌患者 2 5例的临床资料 ,生命统计采用KaplanMeier法及t检验 ,利用COX风险比例回归模型来判断其独立的预后影响因素并进行分析。结果　 2 5例患者的中位年龄为 5 1岁 (33～ 72岁 )。其中 12例 (48% )为浆液性乳头状囊腺癌 ;组织学分级为C3 者 13例 (5 2 % ) ;7例 (2 8% )有锁骨上淋巴结转移 ,6例 (2 4% )有肝转移 ,4例 (16 % )有恶性胸水。所有患者均接受了肿瘤细胞减灭术 ,其中 9例 (36 % )为理想的肿瘤细胞减灭术。 2 5例患者的中位生存时间为 15 .0个月 ,其中理想的肿瘤细胞减灭的中位生存时间为 2 8.4个月 ,而不理想者仅为14.7个月 (P <0 .0 1) ;术后化学治疗达到 6个疗程者的中位生存时间为 2 8.5个月 ,而不足 6个疗程者仅为 6 .5个月 (P <0 .0 1)。通过多因素分析发现 ,理想的肿瘤细胞减灭术和化学治疗疗程数是独立的预后影响因素。结论　在不影响生活质量的前提下 ,理想的肿瘤细胞减灭术及术后积极的化学治疗可以改善Ⅳ期卵巢上皮性癌的预后。     

晚期上皮性卵巢癌经腹腔镜和开腹的初次肿瘤细胞减灭术或中间型减瘤术的临床对比研究

目的:比较经腹腔镜和开腹晚期上皮性卵巢癌初次肿瘤细胞减灭术(PDS)或(IDS)的手术效果,探讨经腹腔镜和IDS用于治疗晚期上皮性卵巢癌的临床效果。方法:选择2009年1月1日至2017年12月31日陆军军医大学附属西南医院妇产科收治的晚期上皮性卵巢癌患者237例,根据手术途径分为腹腔镜组210例,其中96例接受PDS,114例接受IDS;开腹组27例,其中22例接受PDS,5例接受IDS。比较两组的手术风险、术后相关参数和远期疗效。结果:手术风险:腹腔镜组的手术时间、出血量和术中输血、术中损伤比例少于开腹组(P<0.05);术后相关参数:腹腔镜组的住院时间、术后肛门排气时间、术后开始化疗时间、术后并发症少于开腹组(P<0.05)。腹腔镜组内IDS较PDS的手术时间(3.3±1.0小时vs 3.8±1.0小时)和术中输血比例(16.7%vs 33.3%)显著减少,开腹组内IDS较PDS的手术时间(3.4±0.6小时vs 5.2±1.7小时)显著减少,差异均有统计学意义(P<0.05)。腹腔镜组和开腹组的OS和PFS比较,差异无统计学意义(P>0.05);腹腔镜组内PDS和IDS的OS(92.0个月vs 56.0个月)、PFS(26.0个月vs 22.0个月)比较,差异无统计学意义(P>0.05);开腹组内PDS和IDS的OS(57.5个月vs 35.2个月)、PFS(33.0个月vs 17.0个月)比较,差异无统计学意义(P>0.05)。结论:经腹腔镜相较于开腹肿瘤细胞减灭术,IDS相较于PDS,都可以降低手术风险且并不影响患者的预后,对于晚期上皮性卵巢癌患者而言都是合适的治疗方案。