局部晚期子宫颈癌新辅助化疗价值的评估

目的 探讨局部晚期宫颈癌新辅助化疗的疗效及影响近期疗效的相关因素,以及对患者长期生存的影响。方法 收集行新辅助化疗的Ⅰb2—Ⅱb期局部晚期宫颈癌患者64例,分析其化疗后的近期疗效及长期生存率,采用多元线性回归法分析影响化疗近期疗效的相关因素。结果 新辅助化疗的近期总有效率为80％（51／64）。化疗患者的近期疗效与病理类型有关,鳞癌患者的有效率（82％）明显高于腺癌（6／9,P〈0．05）;而与其他因素无关（P〉0．05）。化疗有效者手术后盆腔淋巴结阳性率为8％（4／51）,宫旁血管癌栓阳性率为2％（1／51）,均明显低于化疗无效者（分别为3／6、2／6;P〈0．05）。新辅助化疗后患者的总5年生存率为89％,其中化疗有效者5年生存率为100％,明显高于化疗无效者的46％（P〈0.05）。新辅助化疗有效者3、5年无瘤生存率分别为95％、83％,化疗无效者分别为33％、0,两者分别比较,差异均有统计学意义（P〈0．05）。结论 局部晚期宫颈癌新辅助化疗的近期疗效与病理类型有关,对化疗有效者应选择手术,可提高长期生存率。     

生殖系统原发性恶性黑色素瘤42例临床分析

目的探讨生殖系统原发性恶性黑色素瘤的诊断、治疗及预后影响因素。方法对42例生殖系统原发性恶性黑色素瘤患者的临床和病理资料进行回顾性分析。结果42例患者中,原发于外阴、阴道及宫颈的恶性黑色素瘤患者分别为14例（33％）、23例（55％）及5例（12％）。其中,38例手术治疗前行肿瘤组织活检,6例误诊,术前误诊率为16％;18例术后行免疫组化S-100蛋白检测,18例（100％）均阳性;16例术后行抗黑色素瘤特异性抗体（HMB-45）检测,14例（88％）阳性。本组患者的2年、5年累积无瘤生存率分别为35％及23％,2年、5年累积总生存率分别为53％及27％。按国际妇产科联盟（FIGO,2000年）的分期标准,Ⅰ、Ⅱ期（早期）和Ⅲ、Ⅳ期（晚期）患者的2年累积总生存率分别为77％及34％,两者比较,差异有统计学意义（P〈0．05）;Ⅰ、Ⅱ期患者的2年累积总生存率分别为78％及74％,两者比较,差异无统计学意义（P=0．303）。对40例接受手术治疗患者的临床资料进行单因素分析显示,术后辅助化疗对患者的累积无瘤生存率和累积总生存率有明显影响（P〈0．05）;广泛性手术、区域淋巴结切除、生物治疗对预后则无明显影响（P〉0．05）。化疗联合生物治疗和单纯化疗患者的2年累积无瘤生存率分别为49％及34％,两者比较,差异无统计学意义（P〉0．05）。结论生殖系统原发性恶性黑色素瘤术前活检的误诊率高,应用免疫组化染色检测可提高诊断的准确性。FIGO分期难以准确评价早期患者的预后。手术是主要治疗手段,术后辅助化疗可显著改善患者的预后。     

新辅助化疗在宫颈癌治疗中的应用及疗效观察

目的探讨术前新辅助化疗对局部晚期宫颈癌的治疗效果。方法对55例Ib2～Ⅱb期的宫颈癌患者行新辅助化疗，并对治疗效果进行评价。以同期未行新辅助化疗的33例宫颈癌患者作为对照，比较两组患者术中出血量、宫旁浸润率、阴道切缘阳性率及淋巴结转移率的差异。对患者进行随访，分析新辅助化疗对远期预后的影响。结果新辅助化疗组总有效率为94．6％，病理完全缓解者5例（9．1％）。有效的52例患者接受了手术。新辅助化疗组淋巴结转移率为36．5％，对照组为48．5％，两组比较，无差异（P〉0．05）。但新辅助化疗组中Ⅱ期患者淋巴结转移率（35．3％）低于对照组（69．2％），两者比较，差异有显著性（P〈0．05）。两组的宫旁浸润率分别为1．9％和18．2％，经精确概率法计算，两者比较，差异有显著性（P〈0．05）。术中出血量分别为（874．0±675．6）ml和（493．9±316．7）ml，两者比较，差异有显著性（P〈0．05）。NACT组与对照组的1年无瘤生存率分别为77．78％和81．04％，5年无瘤生存率分别为75．41％和81．04％，1年总生存率分别为93．91％和96．88％，5年总生存率分别为84．37％和88．03％，两组比较，差异均无显著性（P〉0．05）。结论新辅助化疗对局部晚期宫颈癌患者近期疗效显著，但对无瘤生存时间和总生存时间无明显影响。术后化疗、淋巴结转移是影响患者无瘤生存时间的主要因素。     

45岁以下子宫内膜癌40例临床分析

目的探讨45岁以下子宫内膜癌的临床特点。方法对2000年12月至2004年12月间中山大学附属第三医院、中山大学附属第二医院及中山大学附属肿瘤医院妇科收治的189例子宫内膜癌进行回顾性分析，其中≤45岁组40例，〉45岁组149例，比较两组患者的临床特点。结果≤45岁组中原发不孕14例（35．0％），〉45岁组中原发不孕4例（2．7％），两组比较，差异有统计学意义（P〈O．05）；≤45岁组妊娠次数〈3次者28例（70．0％）；〉45岁组妊娠次数〈3次者47例（31．5％），两组比较，差异有统计学意义（P〈0．05）。两组肌层浸润程度比较，差异有统计学意义（P〈O．05）；手术病理分期、病理类型、组织学分级、淋巴转移和附件转移比较，差异无统计学意义（P〉O．05）；≤45岁组的平均生存时间为（77．7±2．5）个月，平均复发时间为（75．2±2．8）个月；〉45岁组的平均生存时间为（76．0±2．2）个月，平均复发时间为（71．4±2．5）个月；两组患者的生存时间、复发时间比较，差异无统计学意义（P〉O．05）。结论不孕少孕是45岁以下子宫内膜癌患者的高危因素，45岁以下子宫内膜癌患者较少发生肌层浸润，预后与大于45岁的患者相似。     

原发性腹膜恶性肿瘤化疗方案的探讨

目的 比较原发性腹膜恶性肿瘤采用不同化疗方案治疗对患者生存时间的影响。方法 对1995年5月．2005年5月在本院治疗的27例原发性腹膜恶性肿瘤患者的临床病理资料进行回顾性分析。结果 全部患者均施行肿瘤细胞减灭术，术后予以铂类为主的方案化疗。24例患者采用TP（紫杉醇＋顺铂／卡铂）或PAC（顺铂＋阿霉素＋环磷酰胺）方案化疗，其中2例失访，2例尚未完成化疗；另有2例患者采用以铂类为主的其他方案化疗，1例未化疗。总结有完整化疗及随访资料的20例患者的生存情况。TP方案组13例，PAC方案组7例。20例患者初次化疗缓解率80％（完全缓解60％，部分缓解20％），无进展中位生存时间16个月（11。21个月），总体中位生存时间42个月（22．3～61．7个月）。TP方案组和PAC方案组患者的年龄、绝经状况、腹水细胞学检查、手术后残余灶大小、手术分期（沿用卵巢癌FIGO分期标准）、病理类型、化疗疗程及化疗毒副反应均无统计学差异。TP方案组患者无进展中位生存时间19个月，PAC方案组12个月，两者比较无统计学差异；TP方案组和PAC方案组患者的平均生存时间分别为69个月和28个月，两者比较，差异有统计学意义（P〈0．05）。结论 原发性腹膜恶性肿瘤采取肿瘤细胞减灭术及铂类为主的化疗方案可改善预后，TP联合化疗可能优于PAC方案延长患者生存时间。     

新辅助化疗对早期巨块型宫颈癌作用的临床分析

目的探讨新辅助化疗对早期巨块型宫颈癌的疗效及相关影响因素。方法对2005年1月至2006年12月中山大学肿瘤防治中心收治的140例Ib～Ⅱa期巨块型宫颈癌患者进行回顾性分析，根据术前是否行新辅助化疗（Neoadjuvant Chemotherapy，NACT）分为两组：NACT组69例，在根治性手术前行1～3个疗程的新辅助化疗；直接手术组71例，术前未接受辅助治疗，直接行根治性手术。术前评价NACT的疗效，并比较两组术中出血量、术后病理特征及并发症。结果NACT总有效率达87．0％；化疗2～3个疗程较1个疗程的有效率高（89．2％和68．1％，P〈0．05）；NACT组与直接手术组术后标本病理检查脉管浸润率分别为4．35％和14．08％（P〈0．05），但两组宫颈肿瘤的深肌层浸润（53．62％和67．61％）、淋巴结转移（26．09％和29．58％）、宫旁浸润（2．90％和1．41％）及术后放疗率（63．77％和74．65％）差异均无显著性（P〉0．05）；两组手术时间及术后并发症亦无差异（P〉0．05），但NACT组较直接手术组术中出血多，术中输血比例高（46．38％和15．49％，P〈0．05）；治疗前鳞状细胞癌抗原（SCC-Ag）≥3．0ng／ml者对NACT的反应率（100％）高于SCC-Ag〈3．0ng／ml者（82．5％，P〈0．05）。术前Hb水平、临床分期、肿瘤直径、肿瘤大体类型、病理组织学类型、肿瘤分化程度与NACT的反应率无关。结论术前新辅助化疗对早期巨块型宫颈癌有较好的近期疗效，NACT可能减少肿瘤的脉管浸润。治疗前SCC-Ag水平可能有助于预测NACT的近期疗效。     

CA125对子宫内膜癌检测及临床意义

目的 探讨血清CA25值对子宫内膜癌早期诊断、监测病情变化和预测预后的价值。方法 用免疫化学法检测55例子宫内膜癌患者和16例良性子宫病变患者血清CA125水平。结果 良性子宫病变和44例手术分期为I期的子宫内膜癌患者血清CA125阳性率分别为19．4％和27．3％，两者相比，P＞0．05，无显著性差异（P＞0．05）。手术分期为I期和10例晚期病人（Ⅲ期＋Ⅳ期）血清CA125的阳性率各为27．3％和70％，两者相比，有显著性差异（P＜0．05）。30例Ia期＋Ib期和14例Ic期病人血清CA1254的阳性率分别为20％和47．8％，两者相比，无显著性差异（P＞0．05）。病理分级中30例G1、20例G2、5例G3血清CA1254的阳性率分别为20％、45％、80％，三者相比，相互之间有显著性差异（P＜0．05）。结论 血清CA125的检测对早期诊断子宫内膜癌缺乏敏感性，对早期内膜癌患者预测手术分期，Ic期无明显的参考价值，但与手术分期和病理分级密切相关，可能对预测预后提供一定的参考价值。     

卵巢上皮性癌组织中磷酸化蛋白激酶B和PTEN蛋白的表达及其意义

目的探讨磷酸化蛋白激酶B（pAKT）和FYEN蛋白在卵巢上皮性癌（卵巢癌）组织中的表达及其相互关系,并分析两者与卵巢癌患者预后的关系。方法应用免疫组化法,检测12份正常卵巢、20份卵巢良性上皮性肿瘤、12份卵巢交界性上皮性肿瘤、80份卵巢癌组织中pAKT和PTEN蛋白的表达,并分析两者间的关系。采用单因素和多因素生存分析法分析pAKT和FYEN蛋白表达与卵巢癌患者预后的关系。结果pAKT蛋白在正常卵巢、卵巢良性上皮性肿瘤组织中的阳性表达率分别为8％、10％。显著低于卵巢癌组织的55％（P〈0．01）;而FYEN蛋白在卵巢癌组织中的阳性表达率为45％,显著低于正常卵巢和良性上皮性肿瘤组织的100％、80％（P〈0．01）。pAKT和FYEN蛋白在交界性肿瘤组织中的阳性表达率分别为25％、67％,分别与卵巢癌组织比较,差异均无统计学意义（P〉0．05）。pAKT和FYEN蛋白表达与卵巢癌手术病理分期、病理分级、有无淋巴结转移和远处转移有关（P〈O．05）,而与年龄、病理类型、有无腹水无关（P〉0．05）。卵巢癌组织中pAKT和PTEN蛋白间的表达呈明显负相关关系（r=-0．444,P〈0．01）。单因素生存分析显示,手术病理分期、病理分级、有无淋巴结转移和远处转移、pAKT和FrEN蛋白阳性表达与患者预后有关（P〈0．05）。Cox回归多因素分析表明,FYEN蛋白阳性表达和手术病理分期是影响卵巢癌患者预后的独立危险因素（P〈0．05）。结论pAKT蛋白过度表达伴随PTEN蛋白表达缺失可能参与卵巢癌的发生、发展,PTEN蛋白表达缺失是卵巢癌患者预后不良的独立危险因素。     

卵巢上皮性癌序贯化疗41例临床分析

目的探讨卵巢上皮性癌不同化疗方案的序贯化疗效果。方法回顾性分析1998年1月-2007年11月肿瘤细胞减灭术后规范化疗的卵巢上皮性癌患者41例,其中序贯化疗组11例,应用化疗方案为TP和／或CAP和／或IAP;常规化疗组30例,应用化疗方案为TP或CAP,比较化疗毒性反应、反应率、无疾病进展期和总生存时间。结果①两组在年龄、病理类型、临床分期、组织分化程度和术后残留病灶方面差异无统计学意义（P〉0．05）;②序贯化疗组的完全缓解率（CR）、部分缓解率（PR）和总缓解率（CR＋PR）分别为57．1％、23．8X和81．oH,常规化疗组的CR、PR和CR＋PR分别为55．3％、23．4％和78．7％,组间比较,差异无统计学意义（P〉0．05）;③序贯化疗组中位无疾病进展和中位总生存时间分别为41个月和60个月,常规化疗组分别为30个月和59个月,较常规化疗组延长,但差异无统计学意义（P〉O．05）;④序贯化疗组发生3～4级白细胞减少症4例,占36．36％,常规化疗组发生10例,占33．33％,组间比较,差异无统计学意义（P〉0．05）;非血液系统化疗毒性反应主要为神经系统毒性反应,序贯化疗组发生3～4级神经系统毒性反应1例（9．09％）,常规化疗组6例（20％）。结论序贯化疗可延长卵巢癌患者的无疾病生存期,且毒性反应减少,有待今后进一步研究后用于卵巢癌一线化疗。     

冷刀锥切术切缘阴性的重度宫颈鳞状上皮内瘤变患者的预后影响因素分析

目的探讨冷刀锥切术切缘阴性的重度宫颈鳞状上皮内瘤变（HSIL）患者的预后影响因素。方法回顾分析1999年1月至2004年1月间,卫生部北京医院妇产科266例冷刀锥切手术切缘阴性的HSIL患者的临床资料,分析影响预后的因素,并随访治疗结局。其中宫颈上皮内瘤变（CIN）II20例,CIN11246例（包括原位癌82例）;腺体累及者40例,无腺体累及者226例;257例检测高危型人乳头状瘤病毒（HPV）患者中,高危型HPV阳性244例,阴性13例。结果中位数随访时间46个月,总复发率为8．6％（23／266）,无浸润癌发生。CINⅡ患者中1例（5．0％,1／20）复发,CINⅢ患者（不包括原位癌）中9例（5．5％,9／164）复发,而82例原位癌中13例（15．8％,13／82）复发,原位癌与CINⅡ及CINⅢ（不包括原位癌）患者复发率比较,差异均有统计学意义（P〈0．05）。腺体累及者中7例（17．5％,7／40）复发,无腺体累及者中16例（6．0％,16／226）复发,两者比较,差异有统计学意义（P〈0．05）。高危型HPV阳性者中21例（8．6％,21／244）复发,而13例高危型HPV阴性者中无一例复发,两者比较,差异有统计学意义（P〈0．05）。结论冷刀锥切术切缘阴性的HSIL复发率低;病理分级高和腺体受累是影响疗效及预后的因素。     

Outcome of patients with unfavorable optimally cytoreduced ovarian cancer treated with chemotherapy and whole abdominal radiation

There is a subgroup of patients with Stage II or III ovarian cancer whose survival is poor despite optimal cytoreduction of tumor and abdominopelvic radiation. This study examined whether the survival of these patients, who have tumor with unfavorable histopathological characteristics and/or small residual disease, could be improved by giving chemotherapy before radiation. Forty-four out of fifty-one eligible patients, seen between 1981 and 1985, with Stage II or III disease were entered into the study. Following six courses of cisplatin-based chemotherapy, 33 (75%) received abdominopelvic radiotherapy. Survival was compared to that of 48 eligible matched control patients, treated with radiation between 1978 and 1981. The median follow-up is 6.6 years. The median survival was extended from 2.4 to 5.7 years (P = 0.13), and 42.6% of patients receiving combined therapy were free of relapse at 5 years, compared to 21.6% (P = 0.03) in the historical control group, treated with abdominopelvic irradiation alone. Only 2 of 44 patients in the combined group required surgery for bowel obstruction, as did 1 of 48 in the control group. Tolerance and toxicity of the combined approach were acceptable. Although we cannot be certain that the entire benefit we observed was not attributable to the chemotherapy alone, there is evidence that the radiotherapy may have been additive. Chemotherapy followed by abdominopelvic radiotherapy seems a reasonable management policy in these patients.     

复发及未控卵巢恶性生殖细胞肿瘤的治疗

目的 探讨复发及未控的卵巢恶性生殖细胞肿瘤的治疗方法及预后.方法 回顾性分析北京协和医院自1983-2008年收治的复发及未控的卵巢恶性乍殖细胞肿瘤患者17例,总结其初次治疗情况(手术和化疗)及未控或复发后的治疗情况及预后.结果 17例患者均接受了肿瘤切除手术,其中只有4例初次手术时可以明确分期情况.除1例在本院进行初次治疗的患者接受了规范化疗(为初治后复发患者)外.其余l6例在外院进行治疗的患者均未经规范的化疗(均为初治后未控的患者),结果在初次手术后1～8个月再次发现肿瘤生长.有15例患者接受了再次肿瘤切除手术,术后进行了及时规范的化疗.8例患者治疗成功,随诊期间未见肿瘸复发;5例因各种原因放弃治疗;4例失访.结论 卵巢恶性生殖细胞肿瘤规范的初次治疗很重要,即使对于复发及未控的肿瘤,仍应积极进行肿瘤细胞减灭术,术后采用规范的化疗,仍有使肿瘤治愈的可能.     

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.     

Paclitaxel-based chemotherapy in carcinoma of the fallopian tube

OBJECTIVE: The objective of this study was to determine the clinical outcomes of patients with fallopian tube carcinoma treated with paclitaxel-based combination chemotherapy following primary cytoreductive surgery. METHODS: Twenty-four patients with the diagnosis of primary tubal adenocarcinoma treated between 1993 and 1998 were identified through the gynecology service database and the Memorial Sloan-Kettering Cancer Center tumor registry. Medical records were reviewed for information on age, stage, chemotherapy regimen, surgical intervention, relapse, and survival. All patients had their histologic material initially read or reviewed at Memorial Sloan-Kettering Cancer Center prior to treatment. The original slides were reviewed again by one of the authors (P.E.S.) to confirm the diagnosis of primary fallopian tube cancer. RESULTS: The mean age of the patients was 63 years (range, 44-76). Distribution by stage was as follows: four patients (17%) were Stage I, three patients (12%) were Stage II, 16 patients (67%) were Stage III, one patient (4%) was Stage IV. Four patients had grade 2 tumors, 20 had grade 3. Sixteen patients (67%) had optimal cytoreduction at the time of initial surgery with residual disease less than 1 cm. Eight patients (33%) had suboptimal cytoreduction. Following initial surgery, all patients were treated with paclitaxel-based chemotherapy for a median of five cycles. Twenty-three patients received paclitaxel at the dose of 135-175 mg/m(2) in combination with carboplatin or cisplatin; the majority, 17 of 23 (74%), received carboplatin. One patient received paclitaxel alone. Median follow-up from time of initial surgery was 24 months (range, 1-73 months). Two patients are dead of disease. Overall survival for the entire group was 96% at 12 months by Kaplan-Meier analysis, and 90% at 3 years. The overall median progression-free survival was 27 months (range, 5-57 months) for the entire group. The median disease progression-free survival at 3 years was 67% (95% CI, 45-100) in the optimally debulked group as compared with 45% in the suboptimally debulked group (95% CI, 27-57). Twelve patients (50%) had evidence of recurrence or persistent disease. There were fewer recurrences in the optimally debulked group: 5 of the 16 patients (31%) versus 7 of the 8 patients (88%) with suboptimal cytoreduction. CONCLUSION: Optimally cytoreduced patients with primary fallopian tube carcinoma treated with a paclitaxel-based chemotherapy regimen have an excellent possibility of survival.     

复发性耐药性卵巢恶性生殖细胞肿瘤的治疗

恶性生殖细胞肿瘤治疗关键是规范化,包括手术切除肿瘤、手术病理分期、术后规范化疗,强调及时、足量、正规,可争取90%以上甚至100%的持续缓解率。初次化疗不规范,病情可能持续不缓解或复发。对于复发性恶性生殖细胞肿瘤,再次肿瘤细胞减灭术有减轻瘤负荷的作用,为术后的化疗奠定基础。复发性卵巢恶性生殖细胞肿瘤术后的二线化疗也至关重要。化疗药物应个体化,化疗的疗程数也强调个体化,有阳性肿瘤标志物的患者治疗应持续至肿瘤标志物降至正常后2个疗程。无阳性的肿瘤标志物的患者治疗应持续4~6个疗程。无性生殖细胞瘤和未成熟畸胎瘤对再次化疗或手术仍有效,预后好。卵黄囊瘤则效果很差。卵巢胚胎癌及原发绒癌很少见,治疗经验少。     

Epithelial Ovarian Carcinoma: Principles of Primary Surgery

Surgery remains the most important facet in the initial management of epithelial ovarian cancer. Initial surgical therapy involves the establishment of the diagnosis, appropriate surgical staging, and primary cytoreductive surgery. For patients with advanced disease, surgical staging of ovarian cancer is obvious, but for apparently early disease (Stage I or II), appropriate surgical staging is extremely important and will result in the upstaging of about one-third of patients (usually to Stage III). The theoretical benefit of initial cytoreductive surgery is the removal of large necrotic tumors with a poor blood supply and the removal of large tumors that are in a slower growth phase, leaving behind tumors that are more sensitive to the effects of chemotherapy. There are multiple clinical studies indicating that "optimal" cytoreduction (removal of all tumor larger than 2 cm) results in improved complete response rates to chemotherapy, improved progression-free and overall survival, and a significant increase in the number of patients who will have a negative second-look surgical reassessment. Recent studies by the Gynecologic Oncology Group have further clarified the role of initial surgery, showing that the "biology" of the tumor is also important and that survival is directly related to residual disease within the following categories: (i) microscopic disease, (ii) optimal disease (2 cm or less in residual diameter), and (iii) suboptimal disease (greater than 2 cm diameter of residual disease). In the latter group (suboptimal disease), there may be a benefit to second attempts at surgical cytoreduction (interval cytoreductive surgery).     

Survival impact of surgical cytoreduction in stage IV epithelial ovarian cancer

OBJECTIVE: The aim of this study was to evaluate the influence of surgical cytoreduction on survival in patients with Stage IV epithelial ovarian cancer and to determine the survival impact of debulking extrahepatic disease in the subgroup of patients with liver metastasis. METHODS: Medical records were retrospectively reviewed for all women with International Federation of Gynecology and Obstetrics Stage IV ovarian cancer treated between 1/1/82 and 12/31/94. Clinical information abstracted included age at diagnosis, performance status, histologic subtype, tumor grade, Stage IV criteria, ascites volume, predominant peritoneal tumor pattern, surgical procedures performed, hepatic tumor residuum, extrahepatic tumor residuum, and postoperative complications. Optimal surgical status was defined as residual disease 相似文献   

The treatment of 48 patients affected by ovarian carcinoma at stages III and IV F.I.G.O

The Authors analyzed the treatment of 28 patients in stage III (FIGO) and 20 patients in stage IV affected by epithelial ovarian cancer. In these cases, surgery was based on the criterion of cytoreduction and, where possible, maximum radicality. Within a month from surgery, all patients underwent a program of combined chemotherapy (VCR + 5 FU + CTX) envisaging successive cycles, every four weeks. Minimal side effects were generally observed. 13/28 (46.4%) responses were recorded in stage III and 4/14 (28.6%) in stage IV. The highest percentage of responses, 80%, was obtained in patients with a residual tumor less than 2 cm, all belonging to stage III. Stage III and stage IV patients with a residual tumor greater than 2 cm responded in 45% and 33% of the cases respectively. Patients who underwent explorative laparotomy showed negligible responses. There was a statistically significant difference survival between stage III and stage IV patients (p less than 0.001), among patients with a similar residual tumor greater than 2 cm, but in different stages (p less than 0.05), and among stage III patients who responded or not to chemotherapy (p less than 0.001).     

Diagnosis and management of epithelial ovarian cancer

Epithelial ovarian cancer is the leading cause of death from gynecologic cancer in the United States. Although there has been a statistically significant improvement in 5-year survival, in 2005 more than 16,000 women were expected to die of this disease. To date, there is no reliable method to screen for ovarian cancer; therefore, the majority of cases are diagnosed with advanced disease. For early ovarian cancer, appropriate surgical staging and adjuvant chemotherapy for selected cases will result in survival rates of 90-95%. For advanced ovarian cancer, survival depends primarily on the success of the initial surgical procedure. Patients with complete cytoreduction to microscopic disease are often cured with adjuvant chemotherapy. There is growing evidence that these patients with microscopic residual disease are excellent candidates for intraperitoneal chemotherapy, and this mode of chemotherapy delivery may be their best opportunity for cure. Patients with optimal cytoreduction also may benefit from intraperitoneal chemotherapy, but cure is less likely. For patients with suboptimal cytoreduction, intravenous chemotherapy with a combination of carboplatin and paclitaxel is the current standard therapy. Most of these patients will experience recurrence of the cancer, with small chance of cure. Salvage chemotherapy is important in ovarian cancer because many patients respond to several salvage regimens. Because of the high response rate of ovarian cancer, even after relapse, it is probably better to consider 10-year survival as the ideal end point. Finally, new biologic agents, in combination with traditional surgery and chemotherapy, may result in further improvement in survival for patients with ovarian cancer.     

晚期卵巢上皮性癌复发的影响因素及处理

目的 探讨晚期卵巢上皮性癌（AEOC）复发的影响因素及复发后的处理。方法 回顾分析了自1986年1月至1997年12月经系统首次治疗后复发的AEOC患者167例进行再次治疗的资料。采用Log-rank检验生存率差异,COX比例风险模型分析预后因素,logistic逐步回归法筛选影响缓解期的因素。结果 患者的中位年龄51岁（26－71岁）。60例行二次手术治疗,其中23例中残留癌直径≤1cm;107例进行再次化学药物治疗（化疗）。影响AEOC复发的因素有年龄,首次术后残留癌直径,一线化疗,先期化疗。二次肿瘤细胞减灭后残留癌直径≤1cm,残留癌直径＞1cm和化疗患者的中位生存时间分别为20,10,13个月（x^2=16.41,P=0.0003),经两两比较发现,残留癌直径≤1cm和化疗患者均比残留癌直径＞1cm患者预后好,并且残留癌直径≤1cm患者的中位生存时间明显长于化疗患者（x^2=3.97,P=0.0462)。二线化疗和未行二线化疗患者的中位生存时间分别为14,10个月,两者比较,差异有显著性（x^2=3.86,P=0.0494)。结论 年龄,首次术后残留癌直径,一线化疗,先期化疗等是影响AEOC复发的主要因素,二线化闻和二次肿瘤细胞减灭术是AEOC复发后有效的治疗手段。