晚期卵巢癌行肿瘤细胞减灭术的预后情况及影响因素分析

目的：分析晚期卵巢癌肿瘤细胞减灭术(CRS)后预后情况及相关影响因素,旨在为临床完善后续诊疗方案提供参考依据。方法：选取2007年6月-2017年12月福建省肿瘤医院收治的50例晚期卵巢癌患者,均给予CRS术治疗。记录术后生存情况,死亡患者纳入死亡组,存活者纳入存活组,采用logistic回归分析晚期卵巢癌行CRS术后预后的影响因素。结果：晚期卵巢癌患者死亡率为44.00%(22/50)。两组腹水、残留病灶直径、血清人附睾蛋白4(HE4)、糖类抗原125(CA125)、白蛋白(ALB)水平比较,差异均有统计学意义(P<0.05)。logistic回归分析表明,有腹水、残留病灶直径>1 cm、血清HE4、CA125水平升高是晚期卵巢癌CRS术后死亡的独立危险因素,ALB水平升高是保护因素(P<0.05)。结论：晚期卵巢癌患者CRS术后预后不佳,腹水、残留病灶直径、血清HE4、CA125、ALB水平是影响其预后的重要因素,故临床需尽早采取针对性干预措施,改善患者预后,延长患者生存期。     

CA125对Ⅲ期卵巢癌细胞减灭术疗效的预测价值

[目的]利用术前血清CA125水平预测Ⅲ期卵巢癌细胞减灭术的可行性。[方法]回顾性分析术前CA125升高的57例Ⅲ期卵巢癌患者。利用ROC曲线方法求出最有临床价值的CA125水平，并进行对比分析。[结果]CA125为500μg/L是判断卵巢肿瘤细胞减灭术可行性的最有临床价值的数据。术前CA125500μg/L预测理想肿瘤细胞减灭术或不理想肿瘤细胞减灭术的敏感性72．7％，特异性为66．7％；阳性预测价值为72．7％，阴性预测价值为66．7％。[结论]术前血清CA125为500μg/L是Ⅲ期卵巢癌术前预测能否施行理想的肿瘤细胞减灭术的最有临床价值的CA125水平。     

卵巢癌肿瘤细胞减灭术的危险因素分析

目的:调查与卵巢癌肿瘤细胞减灭术有关的危险因素.方法:收集2010年1月至2013年12月入院的238例行肿瘤细胞减灭术病人的临床资料,统计分析可能导致手术并发症的因素.结果:白蛋白＜35 g·L-1、血红蛋白＜8 g·L-1、术中出血＞ 400 ml、合并症、腹主动脉旁淋巴结清扫和肠切除等6个因素是卵巢癌肿瘤细胞减灭术的危险因素.结论:在准备行卵巢癌肿瘤细胞减灭术时,对以上危险因素应仔细考虑,有目的地控制相关因素,可以减少卵巢癌肿瘤细胞减灭术有关并发症的发生.     

间歇性肿瘤细胞减灭术治疗晚期卵巢上皮性癌治疗中的疗效探讨

目的:探讨间歇性肿瘤减灭术在晚期卵巢上皮性癌治疗中的临床价值。方法:将我院收治的68例卵巢上皮性癌患者随机分为观察组和对照组,观察组采用间歇性肿瘤减灭术治疗,对照组采用辅助化疗治疗,对比两组患者的治疗前后的临床特征及术后生存状况。结果:观察组的手术时间、住院时间、术中出血量明显优于对照组,术后3年生存率和5年生存率明显高于对照组。结论:间歇性肿瘤细胞减灭术提高卵巢上皮性癌的治疗效果,延长患者生命,具有较高的临床应用价值。     

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.     

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.     

不同肿瘤细胞减灭术式对晚期上皮性卵巢癌患者疗效、免疫功能、生存质量及预后的影响

目的 研究不同肿瘤细胞减灭术治疗晚期上皮性卵巢癌(EOC)患者的临床疗效,及对免疫功能、肿瘤标志物水平及生存质量的影响。方法 以随机数字表法将2019年5月至2021年4月项城市中医院98例晚期EOC患者分为两组。初始瘤细胞减灭术(PDS)组49例予以PDS+化疗,间歇性肿瘤细胞减灭术(IDS)组49例予以PDS+IDS+化疗。对比两组治疗效果、治疗前后肿瘤标志物、细胞免疫功能水平、生存质量(KPS评分)及随访12个月生存率、复发率。结果 IDS组有效率(87.76%)高于PDS组(65.31%)(P<0.05);IDS组治疗后人附睾蛋白(HE4)、癌胚抗原(CEA)水平低于PDS组(P<0.05);治疗后观察组淋巴细胞(CD3⁺、CD4⁺)、CD4⁺/CD8⁺高于PDS组,淋巴细胞CD8⁺低于PDS组(P<0.05);治疗后IDS组生活质量优于PDS组(P<0.05);随访12个月IDS组生存率(85.42%)、复发率(6.25%)与PDS组(82.9...     

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2007年8月～2008年8月收治的手术病理分期为期Ⅲ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例平均年龄52岁(42～62),其中27例(90%)为浆液性乳头状囊腺癌,3例(10%)为黏液性囊腺癌,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,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期Ⅲ卵巢上皮性癌的预后.     

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。     

腹腔镜下卵巢恶性肿瘤细胞减灭术(附4例报告)

报道了2002年10月~2003年6月本科在腹腔镜下完成的4例卵巢恶性肿瘤细胞减灭术病例。从初步的体会看,腹腔镜技术不仅在卵巢癌的诊断、分期和随访中具有肯定作用,在早期癌的肿瘤细胞减灭术中也能达到与开腹手术相同的效果。     

吉西他滨联合卡铂在复发性上皮性卵巢癌治疗中的应用

目的探讨吉西他滨联合卡铂治疗复发性上皮性卵巢癌的有效性和不良反应。方法对76例复发性上皮性卵巢癌患者应用吉西他滨1 000 mg/m2,第1天和第8天静脉滴注;CBP浓度-时间曲线下面积(AUC)=5,第1天静脉滴注;21天为一个疗程。依据世界卫生组织实体瘤疗效评估标准和国际妇科肿瘤学会卵巢癌疗效判断标准进行疗效评定,并观察化疗后不良反应。结果 76例患者中,完全缓解21例(27.63%),部分缓解36例(47.37%),稳定13例(17.11%),进展6例(7.89%);治疗总有效率75.0%(57/76)。患者无进展生存期平均为4.1个月(2～10个月)。化疗后第8天,中性粒细胞减少、血小板减少、红细胞减少、消化道不良反应的发生率分别84.21%、78.95%、26.32%和86.84%;其他不良反应的发生率均低于20%。无死亡病例。结论吉西他滨联合卡铂是治疗复发性上皮性卵巢癌的有效方案,临床疗效较好,安全性高,其不良反应可控制,患者可耐受。     

Evaluation of whether serum tumor markers in patients with epithelial ovarian carcinoma change following chemotherapy

Background  Phenotypic and genotypic heterogeneity is a known feature of many cancers. Whether serum tumor marker kinds vary and change following chemotherapy is still unclear. The aim of this study was to investigate whether there is a change in the expression of serum tumor markers following chemotherapy, and the potential clinical significance in patients with epithelial ovarian carcinoma (EOC) or primary serous peritoneal carcinoma (PSPC).

Methods  Samples were collected before surgery, during chemotherapy and during follow-up for enzyme-linked immunosorbent assay (ELISA)-based evaluation of serum CA-125, CA19-9 and CP2 levels in patients with EOC or PSPC who had received primary debulking surgery followed by adjuvant chemotherapy. In total, 72 patients were examined, including 37 patients with recurrent lesions and 35 patients receiving first-line chemotherapy.

Results  In 35 de novo patients, 20% (7/35) demonstrated a significant changed serum tumor marker kinds among whom the patients with mucinous carcinoma (57.1%, 4/7) showed resistance to chemotherapy. In the 37 recurrent patients, 51.4% (19/37) had changed serum tumor markers, of whom 57.9% (11/19) presented with serous carcinoma. There was no significant difference in median progression-free survival or overall survival in patients with drug-sensitive or drug-resistant recurrence in patients with changed tumor marker kinds relative to those with unchanged markers. However, for patients with changed serum tumor markers there was a trend towards prolonged survival compared with the unchanged serum tumor marker group. In the 17 patients with secondary recurrence, 37.5% (6/17) had changed tumor marker levels. The ratios of CA-125/CP2 and CA-125/CA19-9 were significantly different after either chemotherapy or recurrence.

Conclusions  Serum tumor marker expression in patients with EOC or PSPC may change after chemotherapy or recurrence, indicating that in addition to the markers that are abnormal before surgery, those markers that are normal should also be monitored during chemotherapy and follow-up.

     

多西他赛与奥沙利铂联合治疗复发性上皮性卵巢癌疗效评价

目的 观察和评估多西他赛联合奥沙利铂方案治疗复发性上皮性卵巢癌的临床疗效及安全性.方法 对病理证实为复发性上皮性卵巢癌患者36例进行化疗.给药方案为:多西他赛75mg/m~2,静脉滴注1 h,第1天:奥沙利铂100mg/m~2,静脉滴注2h,第1天.每21 d重复,至少治疗2个周期.结果 接受治疗的36例患者均可评价疗效,完全缓解率为8.3%,部分缓解率为47.2%,总有效率55.6%.主要毒副反应为骨髓抑制和周围神经炎.结论 多西他赛联合奥沙利铂化疗方案治疗复发性上皮性卵巢癌有较好的疗效,毒副反应轻,耐受性好,值得进一步临床研究推广.

Abstract：

Objective To evaluate the efficacy and safety of docetaxel (Taxotere) (DTX) and oxaliplatin (OXA) for treatment of recurrent epithelial ovarian cancer. Methods Thirty-six patients with histologically confirmed recurrent epithelial ovarian cancer received chemotherapy with DTX and OXA. DTX at the dose of 75 mg/m2 was administered on day 1 by intravenous infusion in 60 min, followed by OXA at 100 mg/m~2 given by a 2 h infusion. The chemotherapy cycles were repeated every 21 days, and the patients received at least 2 cycles. Results All the patients were available for response evaluation, among whom 3 (8.3%) showed complete responses and 17 (47.2%) showed partial responses, with an overall response rate of 55.6%. The main adverse effects included hematological toxicities and peripheral neuropathy. Conclusion Combination of DTX and OXA produces good therapeutic effect with tolerable toxicity profile for treatment of recurrent epithelial ovarian cancer.     

Study on Tumor Angiogenesis in Epithelial Ovarian Carcinoma

The tumor angiogenesis has been recognized asthe neovascularization induced by tumor cells, and finally the formation of capillary network to supply thetumor mass. Recently, it has been shown that thetumor angiogenesis played a key role in the occurrence, development, metastasis and prognosis of tumor. Several studies about epithelial ovarian tumorangiogenesis have been reported abroad, but their results are in controversy['J.' The purpose of this studywas to investigate tumor angiogenesis in …     

早期上皮性卵巢癌手术保留生育功能的可行性及安全性分析

目的讨论上皮性卵巢癌手术保留生育功能的可行性及安全性。方法回顾性分析2008年1月-2012年6月我院早期上皮性卵巢癌手术治疗的35例患者的临床资料。结果按国际妇产科联盟（International Federation of Gynecology andObstetrics,FIGO）标准,35例中Ⅰa期10例,Ⅰb期14例,Ⅰc期11例。保留生育功能手术中单侧附件切除4例,9例行分期手术。术后复发5例。术后成功妊娠2例,生育2名健康婴儿。结论对早期上皮性卵巢癌患者实施保留生育功能手术是可行的,但需术后严密随访。     

血清CA125在卵巢上皮性癌中的临床意义

目的：探讨血清CA125在卵巢上皮性癌中的预后价值.方法：采用回顾性分析方法,对2000年1月至2003年5月本科收治的60例卵巢上皮性癌患者手术前后血清CA125水平,及其结合病理、临床分期及预后等临床资料进行分析.结果：术前血清CA125水平与组织类型和临床分期相关（P＜0.05）,术后CA125半衰期＞20 d的复发率高于≤20 d者（P＜0.05）;多因素分析表明,临床分期和CA125半衰期对预后有影响.术后CA125水平的升高可预测复发.结论：卵巢上皮性癌患者术前测定血清CA125水平可初步判断组织类型及临床分期,术后监测血清CA125水平可及时发现复发,并可判断预后.     

KLF9在上皮性卵巢癌组织中的表达及其临床意义

目的探讨Kr俟ppel样转录因子9（KLF9）在上皮性卵巢癌中的表达及其临床意义。方法选取63例有完整临床病理资料及随访>5年的石蜡包埋上皮性卵巢癌组织和正常卵巢上皮组织。采用实时荧光定量聚合酶链反应检测KLF9 mRNA在两组卵巢组织中的表达,应用免疫组织化学法分析KLF9 在两组卵巢中的表达,分析KLF9 表达水平与临床病理参数及患者预后的关系。结果63例卵巢癌组织中,KLF9 mRN为正常上皮组织的（0.44±0.693）倍（p <0.05）。上皮性卵巢癌组织中,KLF9高表达15 例（23.8%）,低表达48 例（76.2%）;在正常卵巢组织中,KLF9 高表达18 例（60%）,低表达12 例（40%）,差异有统计学意义（p <0.05）。癌组织中KLF9低表达与上皮性卵巢癌患者的临床分期、淋巴结转、腹腔积液相关（p <0.05）。KLF9 mRNA高表达组中位生存时间46.8个月（95%CI：26,83）,高于低表达组的32.6个月[（95%CI：12,74）,p =0.002]。肿瘤组织中KLF9阳性细胞高表达组的中位生存时间为50.2 个月（95%CI：32,84）,高于KLF9低表达组的31.1 个月[（95%CI：12,79）,p =0.001]。多因素COX 生存分析表明,KLF9 mRNA 和KLF9 阳性细胞低表达是影响上皮性卵巢癌预后不良的独立指标[HR=2.64（95%CI：1.14,3.56）,p =0.017]和[HR=3.01（95%CI：2.19,4.51）, p=0.010]。结论KLF9 在上皮性卵巢癌组织中表达下调,与上皮性卵巢癌患者预后不良相关。     

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.