中间性肿瘤细胞减灭术对晚期卵巢癌治疗的价值

1 目的 探讨中间性肿瘤细胞减灭术在晚期卵巢癌治疗中的价值。方法 将曾行肿瘤细胞减灭术的晚期上皮性卵巢癌患者按照术前是否化疗分为两组,即初次肿瘤细胞减灭术组和中间性肿瘤细胞减灭术组,进行回顾性分析,比较两组患者与预后有关的指标及生存情况。结果1990年1月～1998年12月,收治ⅢC期、Ⅳ期上皮性卵巢癌患者,并施行了肿瘤细胞减灭术者共71例。其中行初次肿瘤细胞减灭术者45例,行中间性肿瘤细胞减灭术者26例。两组患者除中间性肿瘤细胞减灭术组在术前给予2～4疗程化疗外,手术范围基本相同。中间性肿瘤细胞减灭术组期别晚、分级高,预后不良的组织病理类型所占比例高,但治疗结果两组间达到满意肿瘤细胞减灭术的比例无明显差别。追踪随访初次肿瘤细胞减灭术组,5年生存率40.60％;中间性肿瘤细胞减灭术组,5年生存率对30.72%(P>0.8)。结论 对术前估计难以达到满意的肿瘤细胞减灭术晚期卵巢癌患者,行中间性肿瘤细胞减灭术有可能提高生存率。     

中间性肿瘤细胞减灭术在晚期卵巢上皮性癌中的治疗价值

卵巢上皮性癌发病隐蔽,恶性程度高,晚期患者预后差,传统的初次肿瘤细胞减灭术对于晚期患者常常难以达到理想肿瘤细胞减灭,而术前化疗的广泛应用使得中间性肿瘤细胞减灭术(ICS)受到越来越多的关注.因此就:ICS的概念、发展历程、手术切除率,生存结局、相关并发症以及对晚期卵巢上皮性癌的治疗价值进行综述.     

卵巢癌的初始与间歇性肿瘤细胞减灭术相关问题

临床工作中对晚期卵巢癌患者施行新辅助化疗(neoadjuvant chemotherapy,NACT)的比例逐年增加.尽管基于现有的循证医学证据,晚期上皮性卵巢癌采用NACT联合间歇性肿瘤细胞减灭术有着不低于初始肿瘤细胞减灭术的疗效,更低的术后病率,但目前对于卵巢癌NACT仍存在较多争议.新诊断的晚期卵巢癌患者治疗前需...     

复发性卵巢癌二次肿瘤细胞减灭术患者的选择及其对生存影响的相关研究

晚期卵巢癌的标准治疗方法为肿瘤细胞减灭术后予以铂类为基础的联合化疗,虽然这种组合治疗可以在一定程度上控制疾病的进展,但多数患者会在短时间内复发,一旦复发,治疗将非常棘手.目前,上皮性卵巢癌复发后的治疗方式存在争议,是否先行手术或者化疗意见不一致,二次肿瘤细胞减灭术被认为只对合适的患者有益,手术主要考虑能否完整切除病灶及...     

卵巢癌肿瘤细胞减灭术的并发症及防治

卵巢癌是女性生殖系统最为严重的恶性肿瘤之一,满意的卵巢癌肿瘤细胞减灭术能够改善患者的预后。但这种术式手术范围广、涉及脏器多,围手术期并发症的处置是一个难点。文章结合国内外文献及治疗经验,讨论卵巢癌肿瘤细胞减灭术术中及术后常见并发症类型、原因以及防治策略,为降低此类术式并发症发生率、提高并发症处置能力提供经验。     

间歇性肿瘤细胞减灭术治疗晚期卵巢癌的临床价值探讨

目的探讨间歇性肿瘤细胞减灭术(减灭术)在晚期卵巢上皮性癌治疗中的作用。方法对1993年5月至2002年5月武汉大学中南医院妇瘤科三组卵巢癌病人的生存资料进行回顾分析。其中首次减灭术不满意的62例中,47例先化疗1～3个疗程后行间歇性手术,术后继续化疗6～8个疗程;余15例未行手术,化疗6～8个疗程;同期满意的减灭术加术后化疗6～8个疗程的48例;全部病人均行以铂类为主的联合化疗。结果间歇性手术满意者43例(43/47),手术成功率91.5%,中位生存时间25.5个月,未手术者中位生存时间12.3个月,两者相比差异显著(P<0.05);满意的首次减灭术中位生存时间28.0个月,与满意间歇性手术者比较差异无显著性。结论间歇性肿瘤细胞减灭术对首次手术未达满意的患者有一定积极作用,可提高手术的切除率,延长患者生命,具有较好的疗效。     

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。     

肿瘤细胞减灭术在治疗Ⅳ期卵巢上皮癌中的作用

Ⅳ期卵巢上皮癌患者存在盆腔外转移病灶,尚无公认的理想治疗方案.在Ⅳ期卵巢癌中肿瘤细胞减灭术能达到理想程度,并在延长生存期和改善生活质量方面有积极意义.手术的范围应视病人的具体情况而定,并尽可能使术后残留灶＜2cm.为达到Ⅳ期卵巢癌满意的肿瘤细胞减灭术应强调术前改善患者的全身情况和行先期化疗以利于手术切净肿瘤.     

肿瘤细胞减灭术在治疗Ⅳ期卵巢上皮癌中的作用

Ⅳ期卵巢上皮癌患者存在盆腔外转移病灶，尚无公认的理想治疗方案。在Ⅳ期卵巢癌中肿瘤细胞减灭术能达到理想程度，并在延长生存期和改善生活质量方面有积极意义。手术的范围应视病人的具体情况而定，并尽可能使术后残留灶＜2cm。为达到Ⅳ期卵巢癌满意的肿瘤细胞减灭术应强调术前改善患者的全身情况和行先期化疗以利于手术切净肿瘤。     

Prognostic Factors in Patients Undergoing Primary Cytoreductive Surgery for FIGO Stage IIIC Ovarian,Tubal or Peritoneal Cancer

Objective

The aim of the study is to investigate factors related to overall survival in advanced stage ovarian, tubal, or peritoneal cancer and to identify strong and weak prognostic factors.

Secondary Cytoreductive Surgery for Patients with Recurrent Epithelial Ovarian Carcinoma

OBJECTIVE: The aim of this prospective study was to evaluate the influence of secondary cytoreductive surgery on survival of patients with recurrent epithelial ovarian cancer. METHODS: Between June 1993 and June 1999, 149 patients after primary treatment underwent secondary cytoreductive surgery: 69 (46.3%) had recurrence-free interval (RFI) 7-12 months, 59 (39.6%) RFI 13-24 months, and 21 (14.1%) RFI >24 months. Exclusion criteria included secondary cytoreduction during second-look laparotomy, interval cytoreduction, and palliative surgery in patients with intestinal obstruction or progressive disease. RESULTS: The median follow-up was 27 months. According to multivariate analysis, RFI groups, prior chemotherapy combination, and residual tumor after secondary surgery were associated independently with overall survival. Residual tumor after secondary surgery was by far the most strongly predictive factor for patient's survival (hazard ratio (HR) 2.65; 95% confidence interval (CI) 1.43-4.92). The 2-year survival rates were 22.3, 62.9, and 22.7%, respectively, for patients with RFI 7-12, 13-24, and >24 months. The 5-year survival was 29% for patients with RFI 13-24 months. No patients with RFI 7-12 and >24 months outlived the 4-year estimate. Unexpectedly, RFI >24 months was not correlated significantly with overall survival. However, 17 patients (81%) with RFI >24 months were heavily treated with chemotherapy before secondary surgery. CONCLUSIONS: Patients who have documented gross disease preoperatively should be selected for a secondary debulking operation; the entity of surgical effort would be modulated in relation to previous treatment.     

卵巢恶性生殖细胞肿瘤预后因素分析

目的:分析影响卵巢恶性生殖细胞肿瘤(MOGCT)预后的相关因素.方法:回顾性分析天津医科大学总医院和天津市人民医院1987年1月至2004年12月的65例MOGCT的临床和随访资料,探讨影响MOGCT预后的相关因素.结果:MOGCT总的2年和5年生存率分别为53.64%和51.85%,差异无统计学意义(P0.05).MOGCT的预后因素包括:肿瘤病理类型、FI.GO分期、腹水量和术后残存瘤灶直径.无性细胞瘤和未成熟畸胎瘤是预后较好的病理类型(P0.05),早期预后好于进展期(P0.01),腹水量100 ml(P0.05)和残存瘤灶直径≤2 cm(P0.01)具有较好预后.结论:应重视MOGCT初次治疗时的临床分期、病理类型和腹水量,施行彻底的减瘤术和规范的辅助化学治疗可改善预后,提高患者的生存率和生活质量.     

Intraperitoneal Chemotherapy for Advanced Ovarian and Peritoneal Cancers in Patients Following Interval Debulking Surgery or Primary Cytoreductive Surgery: Tom Baker Cancer Centre Experience From 2006 to 2009

ObjectiveTo describe our experience with cisplatin- and paclitaxel-based IP chemotherapy in patients treated initially with either neoadjuvant chemotherapy and interval debulking surgery (IDS) or primary cytoreductive surgery (PCRS).MethodsWe performed a retrospective review of the records of 67 patients (38 IDS, 29 PCRS) enrolled in the intraperitoneal (IP) chemotherapy program at the Tom Baker Cancer Centre between 2006 and 2009. Information pertaining to patient demographics, IP chemotherapy toxicity, and catheter complications was extracted, and the median time to recurrence was calculated.ResultsMost patients in the study were aged 50 to 70 years and had a diagnosis of stage III serous ovarian cancer. Overall, 295/393 IP cycles (75%) were successfully administered. The proportion of patients completing six cycles of chemotherapy in the IDS and PCRS groups was 53% and 59%, respectively. Frequent (> 25%) Grade 1 to 2 chemotherapy toxicities included fatigue, peripheral neuropathy, and nausea. Catheter complications were observed in 34% of patients (23/67). The recurrence rates for patients completing four or more cycles of IP chemotherapy in the IDS and PCRS groups were 58% and 35%, respectively, with the median time to recurrence approximately one year.ConclusionAlthough IP chemotherapy is well tolerated in both IDS and PCRS patients, the median time to recurrence is shorter than expected.     

56例复发性卵巢癌无瘤生存期影响因素及治疗后预后分析

目的:探讨复发性卵巢癌患者无瘤生存期(DFI)相关影响因素并分析两种治疗方案患者的生存预后。方法:回顾性分析56例复发性卵巢癌患者临床资料。按复发后治疗方法不同分为二次肿瘤细胞减灭术联合术后化疗22例(手术组),单纯化疗34例(化疗组)。结果:1病理类型、组织学分级、临床分期、初次术后化疗疗程数及初次术后残余病灶大小与患者DFI有关(P0.05),年龄与DFI无关(P0.05);多因素分析提示临床分期、初次术后残余病灶大小是DFI独立影响因素,临床分期越早、初次术后残余病灶越小,DFI越长。2手术组较化疗组复发后中位生存时间明显延长,分别为30月与16月(χ~2=10.849,P=0.010)。复发后化疗组1、2、3、4年生存率分别为65%,32%,8%,0,手术组分别为95%,75%,29%,0;手术组复发后生存率较化疗组高,差异有统计学意义(P0.05)。结论:复发性卵巢癌患者DFI与病理类型、组织学分级、临床分期、初次术后化疗疗程数及初次术后残余病灶大小相关,临床分期、初次术后残余病灶大小是DFI的独立影响因素。二次肿瘤细胞减灭术联合化疗可提高患者复发后的近期生存率。     

The Significance of Duration of Chemotherapy Interruptions Due to Interval Surgery in Ovarian Cancer Patients Treated With Neoadjuvant Chemotherapy

ObjectiveTo examine the prognostic significance of interruptions to chemotherapy arising from delayed primary surgical debulking following neoadjuvant chemotherapy in women undergoing treatment for ovarian cancer.MethodsWe carried out a retrospective chart review to identify women with ovarian cancer who were treated with neoadjuvant chemotherapy and planned delayed primary surgical debulking. Cox regression modelling was used to identify significant predictors of progression-free and overall survival, using well-established prognostic variables and time delays between courses of chemotherapy perioperatively, stratified by residual disease status.ResultsNinety-seven patients with complete data were identified. Their median age was 65.4 years. Fifty-four patients (56%) were left with optimal residual disease (< 1 cm), and 43 patients had suboptimal residual disease. The median delay from the last cycle of chemotherapy to the time of surgery was 29 days (range 20–72). The median delay from surgery to resumption of cytotoxic therapy was 23 days (range 8–65). Chemotherapy courses were interrupted for a median of 50 days (range 36–119) around the time of surgery. No effect was observed on progression-free interval by interruptions to chemotherapy, regardless of residual disease status. With respect to overall survival, the time to resumption of chemotherapy in days and the time delay in days between the two chemotherapy cycles peri-operatively were identified as statistically significant predictors only in patients with suboptimal residual disease. In patients with optimal residual disease status, neither the time of interruption between the two chemotherapy cycles peri-operatively nor the time to resumption of chemotherapy after surgical debulking was significantly predictive of overall survival.ConclusionIn women undergoing treatment for ovarian cancer, the interval between surgery and the resumption of chemotherapy in patients with suboptimal residual disease should be kept as short as possible.     

1396例子宫平滑肌肉瘤的预后和生存因素

本研究旨在探讨与子宫平滑肌肉瘤(LMS)的病变特别生存(disease-specific survival,DSS)相关的预后因素,分析淋巴结切除在治疗中的作用.     

阴式辅助技术在盆腔高负荷卵巢癌肿瘤细胞减灭术中的应用

目的:探讨经阴道、直肠指示的辅助技术(简称阴式辅助技术)在盆腔高负荷卵巢癌肿瘤细胞减灭术中的应用价值。方法:对38例盆腔高负荷卵巢癌患者在行肿瘤细胞减灭术时采用阴式辅助技术。观察盆腔减瘤结局、脏器保留情况、相关并发症及远期复发情况。结果:全腹盆腔理想减瘤31例(81.6%);盆腔理想减瘤36例(94.7%),其中肉眼无瘤14例(36.8%);直肠、乙状结肠切除18例(47.4%),均达到理想减瘤;直肠、乙状结肠保留20例(52.6%),理想减瘤18例(90.0%)。术中盆腔副损伤5例(13.2%),术后直肠、乙状结肠吻合口瘘并盆腔感染1例,下肢静脉血栓2例;无围手术期死亡病例。34例随访患者中复发11例,分别为单纯盆腔复发2例、盆腔合并其他部位复发4例及盆腔外其他部位单发或多发转移5例,远期局部复发率为17.6%(6/34),复发病例中2例死亡。结论:阴式辅助技术用于盆腔高负荷卵巢癌肿瘤细胞减灭术,盆腔减瘤效果理想,最大限度保留了直肠、乙状结肠,安全可行,远期局部复发率低。     

Analysis of Outcomes and Prognostic Factors after Fertility-Sparing Surgery in Patients with Early Stage Juvenile Granulosa Cell Tumor of the Ovary: Experience from a Tertiary Center

Study ObjectiveThe objective of the study was to analyze the oncological outcomes and prognostic factors in patients with early-stage juvenile granulosa cell tumor (JGCT) who underwent fertility-sparing surgery.Design, Setting, and ParticipantsAll patients with early-stage JGCT who underwent fertility-sparing surgery between January 1995 and December 2017 were reviewed retrospectively.InterventionsNone.Main Outcome MeasuresThe risk factors for recurrence and death in patients with early-stage JGCT were identified.ResultsThirty-five patients were eligible for the current study. The median age was 17 years (range: 4-30 years), and 10 patients were premenarchal. Nine patients were International Federation of Obstetrics and Gynecology stage IA, and 26 were stage IC. Eight subjects underwent complete staging, whereas 28 had no staging at their initial surgery. In those without initial staging, 3 patients who received initial unilateral salpingo-oophorectomy (USO) and 6 with initial cystectomy underwent secondary surgery for staging or USO with staging, respectively. At the time of the secondary staging operation, 1 of the subjects (treated with USO at initial surgery) was found to be stage III and was excluded from this study. Therefore, 8 patients underwent secondary staging surgery performed by laparoscopic surgery, and none of them suffered recurrence during follow-up. Fourteen of the 16 patients with complete staging surgery underwent lymphadenectomy, and none of them had lymph node metastasis. Thirty-one patients received adjuvant chemotherapy after surgery. Eight patients had disease recurrence after a median follow-up time of 51 months (range: 6-229 months), with a median time to recurrence of 4.5 months (range: 2-52 months). Six patients died of their disease. The 5-year disease-free and overall survival rates were 74.8% and 84.3%, respectively. Univariate analysis showed that incomplete staging surgery was associated with increased risk of recurrence (P = 0.029). Adjuvant chemotherapy was not associated with disease-free survival. Four patients had a total of 6 pregnancies, resulting in 6 live births.ConclusionComplete surgical staging is recommended for early-stage JGCT, but lymph node dissection can be omitted. Laparoscopic restaging surgery is feasible for patients with incomplete staging at initial surgery. However, the prognosis of patients with relapsed JGCT remains poor.