新辅助化疗在晚期卵巢癌中的疗效评价

卵巢癌是目前复发率、病死率较高的妇科恶性肿瘤,特别是晚期卵巢癌,其中肿瘤细胞减灭术未能切除的大块残留病灶是导致患者术后化疗耐药、复发及预后不良的重要原因。近三十年的临床观察证实,新辅助化疗可缩小晚期卵巢癌原发灶及转移灶的体积,提高理想细胞减灭术的成功率,从而改善患者预后。近年临床观察发现,虽然新辅助化疗能提高部分晚期卵巢癌手术彻底性,但患者生存期并未得到有效延长。因此需要对新辅助化疗在晚期卵巢癌中的疗效及意义进行客观评价。     

新辅助化疗治疗晚期上皮性卵巢癌的研究进展

上皮性卵巢癌的标准治疗方案为满意的肿瘤细胞减灭术及术后辅以铂类为基础的化疗,其中满意的肿瘤细胞减灭术是治疗成功的基础。但部分患者首次手术无法达到满意的肿瘤细胞减灭术。新辅助化疗治疗晚期卵巢癌受到越来越多的关注。结合文献对新辅助化疗在晚期上皮性卵巢癌治疗中研究热点进行总结分析,认为新辅助化疗提高了满意缩瘤术的几率,然而并未改善患者的预后。临床工作中应准确评估治疗前风险,选择最有可能从新辅助化疗中获益的合适晚期上皮性卵巢癌患者,最大发挥新辅助化疗的作用。     

新辅助化疗在晚期卵巢癌治疗中的应用

卵巢癌患者确诊时多数已属晚期,预后差,能否实现满意的肿瘤细胞减灭术与患者的预后密切相关。新辅助化疗可以提高肿瘤细胞减灭术达到满意缩瘤的几率,减少围手术期并发症的发生,提高患者的生活质量,与直接行肿瘤细胞减灭术相比患者的预后相似。新辅助化疗联合间歇性肿瘤细胞减灭术的治疗方案可能更适合晚期卵巢癌患者。     

新辅助化疗治疗晚期卵巢癌的Meta分析

目的:评价新辅助化疗对晚期卵巢癌患者手术及预后的影响,探讨新辅助化疗在晚期卵巢癌中的应用。方法:计算机检索Pubmed、Cochrane Library、Embase,检索时限为1990年1月1日至2014年8月31日,纳入新辅助化疗后行间歇型肿瘤细胞减灭术与初始肿瘤细胞减灭术相比较的随机对照实验或观察性研究。结果:最终纳入20个研究,共3827例患者。Meta分析结果示:新辅助化疗后间歇型肿瘤细胞减灭术满意缩瘤术率(75.1%)高于初始肿瘤细胞减灭术(59.7%),差异有统计学意义(P0.00001);两组无进展生存期分别为15.2月、13.0月,总生存期分别为33.2月、38.7月,差异均无统计学意义(P0.05)。结论:新辅助化疗可以显著提高晚期卵巢癌患者肿瘤细胞减灭术满意缩瘤术的几率,但不改善无进展生存期与总生存期。     

卵巢癌新辅助化疗相关问题

卵巢癌的标准治疗方案是以手术为主,术后辅以化疗。能否实现理想的肿瘤细胞减灭术将直接影响患者的预后。而大多数晚期卵巢癌患者的初次肿瘤细胞减灭术难以达到满意。新辅助化疗可以改善晚期卵巢癌患者的术前状态,缩小癌灶,缓解病情,为手术的实施和理想肿瘤细胞减灭术的完成创造有利条件。     

卵巢癌的先期化疗

卵巢癌的标准治疗方案即先行肿瘤细胞减灭术,继以铂类药物为基础的联合化疗。然而由于卵巢癌起病隐匿,多数患者确诊时已属晚期,施行理想的肿瘤细胞减灭术较为困难,不同文献报道晚期卵巢癌患者能成功手术的比例差异较大,平均仅为40%～50%。由于未能成功进行肿瘤细胞减灭术的患者,后续化疗也难以取得理想疗效,因而有学者探索在首次手术前先进行有限疗程的化疗,即卵巢癌的先期化疗(新辅助化疗),以减低肿瘤负荷,提高肿瘤细胞减灭术的成功率,以期改善晚期卵巢癌患者的预后。目前对先期化疗能否提高卵巢癌患者的生存率尚存在争议,但对于晚期患者颇…     

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。     

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由专业的妇科肿瘤医生（必要时多学科）评估,对可达到满意细胞减灭术患者应首选初始肿瘤细胞减灭术,对围手术期风险高和（或）无法达到满意肿瘤切除的晚期卵巢癌患者,可给予铂为基础的NACT联合间歇性肿瘤细胞减灭术。     

卵巢癌初始治疗中手术相关若干问题及临床意义

卵巢癌的初始治疗是影响患者预后的最重要因素.早期卵巢癌要进行全面的开腹分期手术,如初次手术未做到全面分期,应在化疗开始前进行再分期手术.晚期卵巢癌要争取在高级别的妇科肿瘤中心进行初次的满意的肿瘤细胞减灭术,特别要重视上腹部手术,力争做到无肉眼残留病灶.新辅助化疗和间歇性肿瘤细胞减灭术可以选择性地应用于部分晚期不适合直接...     

新辅助化疗对晚期卵巢癌长期生存率的研究

为了比较晚期卵巢癌妇女细胞减灭术前施行新辅助化疗和传统的减灭术后应用细胞毒化疗(常规组)两者的无瘤生存(progression-free survival)和总生存率,Yale-New Haven医疗中心回顾性研究了1979～1996年间59例诊断患有晚期卵巢癌而施行以铂类为主的新辅助化疗的患者,通过体格检查、CT扫描和细胞学或组织学检查确定诊断。并与206例Ⅲ期或Ⅳ期卵巢癌先行细胞减灭术然后以铂类为主联合化疗的常规组进行对照分析。 新辅助化疗组接受以铂类为主的联合化疗(顺     

Neoadjuvant chemotherapy for advanced epithelial ovarian carcinoma: a retrospective case-control study

Neoadjuvant chemotherapy has been proposed as an alternative approach to primary cytoreductive surgery as initial management of bulky ovarian cancer with the aim of improving surgical efficiency and quality of life. The data of a retrospective case-control study including 75 patients with advanced epithelial ovarian carcinoma Stages IIIC and IV are presented. In 20 patients, neoadjuvant chemotherapy (3-5 cycles of cytostatics) was applied before cytoreductive surgery which was followed by chemotherapy, six cycles in total. In 55 patients cytoreductive surgery was applied as the primary treatment followed by six cycles of chemotherapy. A comparison of both groups of patients showed no significant difference regarding patient age, tumor stage, grade and treatment modality (chemotherapy and surgery, without irradiation) applied cytostatics and total number of chemotherapeutic cycles. The data from our study confirmed a statistically significant difference in radicality of cytoreduction that was more extensive when applied in combination with neoadjuvant chemotherapy than when applied as primary cytoreductive surgery (p = 0.009). No statistically significant difference was found in the survival of the two groups (p = 0.79), the response to primary treatment (p = 0.52), relapse (p = 0.88) or disease-free survival (p = 0.61). From the findings of the study and literature review, we may conclude that neoadjuvant chemotherapy followed by interval debulking surgery in patients with advanced epithelial ovarian carcinoma does not have an unfavorable effect on the prognosis.     

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.     

Quality of life in women treated with neoadjuvant chemotherapy for advanced ovarian cancer: a prospective longitudinal study

OBJECTIVE: The purpose was to examine the outcomes of patients with advanced ovarian cancer treated with neoadjuvant chemotherapy, with a special emphasis on the patients' quality of life (QOL). METHODS: Seventeen patients with advanced ovarian cancer were treated with neoadjuvant chemotherapy based on the extent of disease on computer tomography. All patients received combined platinum/paclitaxel chemotherapy. Debulking surgery was performed after three cycles or six cycles of chemotherapy, depending on the response to the chemotherapy. Patients' QOL was studied over time using European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 and was then compared with that of patients treated with conventional treatment in the previous cohort. RESULTS: The response rate to chemotherapy assessed at three cycles was 82.4%. The rate of optimum debulking to residual disease less than 2 cm after chemotherapy was 76.9%, and 38.5% had no gross residual disease after surgery. The median overall survival was 22.9 months. The median disease-free interval was 13.3 months. The overall QOL improved after chemotherapy and this continued to improve up to 12 months. The other functional scales also showed improvements over time, apart from the initial transient deterioration in the role functioning and cognitive functioning at 3 months after chemotherapy. Patients treated with neoadjuvant chemotherapy seem to have better but statistically insignificant difference in QOL parameters than patients treated conventionally. CONCLUSION: Neoadjuvant chemotherapy is an alternative treatment for patients with advanced ovarian cancer in whom the chance of optimal cytoreduction is low. The patients' overall quality of life and functional status improve after neoadjuvant chemotherapy.     

Neoadjuvant chemotherapy for the management of ovarian cancer

Neoadjuvant chemotherapy refers to the administration of chemotherapy before definitive surgery is performed; this approach was introduced into the management of ovarian cancer approximately one decade ago, initially for use in women who were medically unable to tolerate aggressive cytoreductive surgery. Subsequently, neoadjuvant chemotherapy was employed in women who, by diagnostic imaging analysis, were unlikely to undergo successful optimal cytoreductive surgery. Only very limited data are available on the use of neoadjuvant chemotherapy in the management of women with apparent advanced ovarian cancer; these data are derived mainly from single institution experiences and suggest that this approach may increase disease-free survival but does not improve overall survival for the patient. However, it has consistently enhanced the feasibility of optimum surgical cytoreduction once neoadjuvant chemotherapy has been administered. Reduced blood loss, and shorter operations, intensive care unit stays and overall hospitalizations have been well documented. The methods for selecting candidates for neoadjuvant chemotherapy vary among institutions. Non-optimal surgical cytoreducibility has been assessed on the basis of diagnostic imaging studies, laparoscopic assessment and/or laparotomies. Currently, neoadjuvant chemotherapy is most beneficial for women who are medically impaired and unable to tolerate aggressive cytoreductive surgery and for women who are found to have such aggressive cancers that optimal cytoreductive surgery does not appear by diagnostic imaging or direct visualization to be possible.     

卵巢上皮性癌新辅助化疗后血清CA125水平下降至一半所需的时间与手术切净率及预后的关系

目的 探讨卵巢上皮性癌新辅助化疗后血清CA125,水平下降至一半所需的时间（即CA15的T1/2）与手术切净率及预后的关系。方法 回顾性分析39例行新辅助化疗的卵巢上皮性癌患者,以化疗后CA125的T1/2长短分组,分为T1/2〈20d组和T1/2≥20d组,比较两组间的手术切净率及预后。结果 新辅助化疗后T1/2≥120d组的手术切净率明显低于T1/2〈20d组（分别为29％和80％,P〈0．01）。T1/2≥20d组的中位生存时间为21.2个月,明显低于T1/2〈20d组的37．6个月（P〈0．05）;两组累计生存率比较,差异有统计学意义（P〈0．01）。多因素分析提示,血清CA125的T1/2及术后残留灶直径是卵巢上皮性癌患者新辅助化疗后影响其预后的独立因素。结论 卵巢上皮性癌新辅助化疗后,血清CA125的T1/2长短有助于术前判断手术切净情况,并且是影响此类患者预后的独立因素。     

Up-date on cytoreductive surgery in the management of advanced ovarian cancer

Epithelial ovarian cancer represents the most aggressive neoplasm of women genital apparatus with a total 5-year survival rate ranging from 17% to 35% if the disease is in the metastatic phase. Its aggressiveness derives from the fact that it is an asymptomatic disease until it spreads in abdominal cavity. Therefore, in 70% of the cases, the diagnosis is done when tumor is already in advanced phase (Stage FIGO IIB-IV). Data from international literature suggest that standard treatment for advanced ovarian cancer is optimal cytoreductive surgery with adjuvant chemotherapy platinum-based. However, in the last decades, many authors have described the enthusiastic results of neoadjuvant chemotherapy and interval debulking surgery. Griffiths, first, underlined the importance of residual mass after cytoreductive surgery as a prognostic factor. Currently, cytoreduction is defined optimal when residual mass is microscopical or absent. Nevertheless, surgery for ovarian cancer turns out to be a particularly aggressive surgery that needs an operator's remarkable technical ability and a cultural Background: Many studies demonstrated that the frequency of feasibility of optimal cytoreductive surgery also varies within the gynecologic oncology specialized centers. During the last few years, new technologies (such as Cavitron Ultrasonic Surgical Aspirator, CUSA, and argon's coagulator) and new surgical techniques have been introduced. Ovarian cancer turns out to be a particularly chemosensitive tumor. Its responsiveness has been the object of numerous studies and protocols in literature, such as European Organisation of Research and Treatment of Cancer (EORTC) and Gynecologic Oncology Group (GOG) trials.     

Influence of surgery and postoperative therapy and tumor characteristics on patient prognosis in advanced ovarian carcinomas

OBJECTIVES: The prognosis in advanced ovarian cancer depends on clinical, morphological, biological and therapeutic variables. However, little is known about their real influences and interrelationships. STUDY DESIGN: One hundred and nineteen long-term, follow-up patients with advanced ovarian carcinoma were analyzed. Overall survival was related to the extent of debulking surgery, response to chemotherapy and several clinicomorphological, histopathological, and immunohistochemical variables. RESULTS: Among all variables, both radical surgery and response to chemotherapy exerted the greatest influence on patient prognosis as shown in both univariate and multifactorial analyses. Most established prognostic factors were of minor importance. Success of chemotherapy correlated with lower residual tumor volume, CA125 expression, FIGO-stage, and serous tumor type. CONCLUSION: Prognosis and chemotherapeutic success in advanced ovarian cancer seem to be interrelated and may be influenced by the intensity of surgical interventions. This demands for greatest cytoreduction during initial surgery and correction for residual tumor volume and success of therapy in studies of prognostic factors.     

Discordance between beliefs and recommendations of gynecologic oncologists in ovarian cancer management.

PURPOSE: The purpose of this study was to determine how physician experts make decisions for clinical scenarios in ovarian cancer and describe a profile of factors reported to influence treatment decisions. METHODS: A questionnaire was sent to Full Members of the Society of Gynecologic Oncologists regarding surgery and chemotherapy for scenarios of primary and recurrent ovarian cancer. RESULTS: In a scenario of primary presentation, 94% of respondents chose a treatment of tumor resection over chemotherapy. Despite the preference for surgery in a clinical scenario, 50% agreed with a statement that neoadjuvant chemotherapy is equivalent to primary surgery. In a scenario of recurrent disease, a comparable number of respondents chose a treatment of secondary cytoreductive surgery (45%) versus direct retreatment with chemotherapy (49%). Those choosing surgery responded that they believed in extensive surgery to achieve optimal cytoreduction. Most (62%) respondents described themselves as collaborative in treatment planning, yet only 24% reported that patient preference strongly influences their decision making. CONCLUSIONS: Although a plan for primary cytoreduction is favored, in specific scenarios, views were divided for the role of neoadjuvant chemotherapy. For a recurrent disease scenario, support was divided between secondary cytoreductive surgery and direct retreatment with chemotherapy. Further clinical research is necessary to minimize the discordance between physician beliefs and recommendations.