保留生育功能手术对治疗上皮性卵巢癌安全性的系统评价

[目的]系统评价保留生育手术治疗上皮性卵巢癌的生存率、复发率和术后妊娠情况。[方法]计算机检索Pubmed（1953～2009）以及截至2009年底的中文全文数据库,对符合纳入标准的随机对照试验,采用RevMan4.3软件进行Meta分析。对于无对照临床研究资料,采用同质合并分析。[结果]共纳入4个保留生育手术和手术治疗卵巢癌生存率比较的临床对照试验和14个无对照的临床研究。Meta分析结果表明,保留生育功能手术和根治性手术治疗上皮性卵巢癌的生存率差异无统计学意义（OR=1.05,95%CI为0.73～1.50,P=0.80）。14篇分析保留生育功能手术的临床研究中,7篇临床病例研究详细记录和分析了有生育要求并尝试怀孕和实际成功受孕的例数,并计算出总的妊娠率为48%。[结论]保留生育手术不会降低年轻的早期上皮性卵巢癌患者的生存期,且能维持正常的妊娠和生育功能,提高了患者生存质量。     

早期上皮性卵巢癌保留生育功能手术的安全性及可行性探讨

目的探讨早期上皮性卵巢癌保留生育功能手术的安全性及可行性。方法选取33例早期上皮性卵巢癌患者为研究对象,根据患者自愿选择治疗方式,将其分为保留生育功能手术组和卵巢癌根治性手术组。评估两组的近期疗效并随访2年;记录患者随访期间复发情况、手术前后月经变化情况及孕产情况等。结果在33例患者中,15例选择保留生育功能手术,18例选择卵巢癌根治性手术;在随访期内,保留生育功能手术患者中3例复发,11例月经恢复正常,5例孕育成功并分娩健康儿;两组患者随访期间生存率比较差异无统计学意义(P>0.05);卵巢癌根治性手术组和保留生育功能手术组的部分缓解率为46.7%和27.8%。疾病控制率分别为86.7%和55.6%。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,且临床较为安全,但需加强术后随访和指导,以提高临床安全性。     

保留生育功能手术治疗早期上皮性卵巢癌患者的临床疗效及术后妊娠情况的影响因素

目的 探讨保留生育功能手术治疗早期上皮性卵巢癌患者的临床疗效及术后妊娠情况的影响因素。方法 根据手术方法的不同将104例早期上皮性卵巢癌患者分为对照组(n=53,卵巢癌根治术)和观察组(n=51,保留生育功能手术)。比较两组患者的围手术期指标、并发症发生情况及复发情况,记录观察组患者的月经恢复及妊娠情况。采用Logistic回归模型分析保留生育功能手术后早期上皮性卵巢癌患者妊娠情况的影响因素。结果 观察组患者术中出血量明显少于对照组,手术时间明显长于对照组,住院时间明显短于对照组,差异均有统计学意义(P<0.01)。两组患者的并发症总发生率及1、2年复发率比较,差异均无统计学意义(P> 0.05)。随访2年,观察组中27例患者尝试受孕,其中9例患者妊娠成功,纳入妊娠组;另外18例患者妊娠失败,纳入未妊娠组。单因素分析结果显示,妊娠组和未妊娠组患者的临床分期、化疗情况及复发情况比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,临床分期、化疗情况及复发情况均是保留生育功能手术后早期上皮性卵巢癌患者妊娠情况的独立影响因素(P<0.05)...     

上皮性卵巢癌复发的影响因素分析

背景与目的:中晚期上皮性卵巢癌复发率较高,生存率低。在没有可靠的早期诊断技术的情况下,了解其复发的影响因素对于预后的判断和指导治疗具有非常重要的意义。本文旨在探讨上皮性卵巢癌复发的影响因素。方法:109例上皮性卵巢癌,对可能导致病人复发的影响因素:年龄,病理类型,临床分期,新辅助化疗,术后化疗方案和化疗疗程,初次手术治疗情况;以及手术残留癌灶大小,用Logistic回归方法进行回顾性总结和分析。结果:109例患者中复发36例,复发率为33.0％,中位复发时间19个月;109例病人总的5年生存率为62.7％,复发病人5年生存率43.3％;盆腔复发病人的5年生存率为50.1％,盆腔外复发病人的5年生存率36.1％,二者相比较无统计学意义(P>0.05)。单因素分析分别显示粘液性腺癌和临床分期为Ⅰ期的复发风险较低(回归系数β=1.565和-1.799,P=0.0120和0.026);而化疗疗程>8个疗程的病人复发风险明显高于1～4疗程和6～8疗程 的病人(回归系数β=-3.591和-1.500,P<0.001和=0.038)。多因素分析显示病理类型、临床分期和术后化疗疗程数是影响卵巢癌治疗后复发的独立危险因素(RR=3.473,4.713和6.140,P<0.05)。结论:临床分期是影响复发的显著因素,早期诊断对于降低卵巢癌复发率十分重要。合理的化疗计划对于卵巢癌的治疗是必要的,     

保留生育功能手术对交界性卵巢肿瘤患者生育结局的影响

目的 分析保留生育功能手术对交界性卵巢肿瘤(BOT)患者生育结局的影响。方法 回顾性分析97例保留生育功能手术的BOT患者临床资料,依据妊娠结局分析其影响因素。结果 97例BOT患者中42例无生育需求,55例有生育需求。55例有生育需求的患者中妊娠患者26例,妊娠率为47.27%(26/55)。妊娠组年龄为(32.13±3.05)岁,小于未妊娠组(48.17±10.05)岁,有统计学差异(P<0.05);2组在FIGO分期、生育史、不孕史、组织学类型、附件手术史、肿瘤部位、浸润性种植、手术方法、术前CA125水平及肿瘤直径等方面对比,无统计学差异(P>0.05)。经Pearson相关性检验结果显示,BOT患者生育结局与年龄呈负相关(P<0.05)。结论 BOT患者采用保留生育功能手术治疗是安全可行的,对患者生育结局无影响,年龄为影响患者生育结局的重要因素。     

早期卵巢癌患者保留生育功能治疗的临床研究进展

卵巢恶性肿瘤的发病率不断升高且呈现年轻化趋势,其中卵巢癌约占90%,随着二胎时代的到来,生育年龄的推迟,患者有更强烈的生育要求,因此,早期卵巢癌的保留生育功能治疗成为目前研究的热点,治疗手段仍在不断探索,其中对于保留生育功能手术（Fertility-sparing surgery,FSS）的适应证、化疗药物对卵巢功能的损伤及如何有效保护卵巢生殖功能等尚有很多争议,本文将就相关研究的进展进行综述。     

早期子宫颈癌保留生育功能手术的研究进展

早期子宫颈癌保留生育功能手术的开展是妇科恶性肿瘤治疗的里程碑之一,其治疗效果逐步得到妇产科医生和患者的肯定,如何更优化的选择及评估患者、提高手术效果、减少并发症、改善肿瘤结局和妊娠结局是目前的热点问题.文章通过对近年国内外治疗的新进展及尚存争议的问题进行综述,以期推动今后的治疗不断向安全、高效、微创的方向发展,在获得临床治愈的前提下更好地改善患者的生活质量.     

CBP方案治疗上皮性卵巢癌

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上皮性卵巢癌预后因素的研究进展

卵巢癌是女性生殖系统中最常见的肿瘤之一,其中上皮性卵巢癌是卵巢癌最常见的病理类型。约70%的上皮性卵巢癌患者被诊断时已经是晚期,因此早发现、早诊断、早治疗是提高上皮性卵巢癌患者生存率的重要方法之一。上皮性卵巢癌的标准治疗方式为细胞瘤减灭术及铂类为主的化疗,但是随着肿瘤细胞对化疗产生耐药性大多数患者在医治后容易复发,患者存活率一般都很低并且疾病很难控制。近年来,对上皮性卵巢癌发病的分子机制的研究不断进展,发现了更多影响上皮性卵巢癌预后的因素,并且可作为潜在的治疗靶点提高患者生存率。     

影响复发上皮卵巢癌手术疗效的临床病理因素分析

  目的  分析影响复发卵巢上皮癌手术疗效的相关临床病理因素。   方法  采用Logistic回归方法进行分析, 并通过多因素Logistic逐步回归分析对接受手术治疗60例复发卵巢上皮性癌患者进行影响手术疗效的临床病理因素相关分析。   结果   1) 60例复发卵巢上皮癌术后平均中位生存时间为26个月(95%CI: 1 8.302~33.698), 其中肿瘤细胞减灭术满意者(残留灶≤2 cm)中位生存时间为28个月(95%CI: 25.043~30.957), 不满意者为16个月(95%CI: 13.184~18.816, P=0.002)。2)Logistic回归单因素分析显示复发数目、复发时伴有腹水、复发部位是影响手术满意效果的因素(P < 0.05);而年龄、初次手术情况、病理类型、细胞学分级、手术病理分期、初次化疗方案、复发距离末次化疗时间、复发CA125水平、最大复发病灶直径大小、术前先期化疗对手术效果无明显影响(P > 0.05)。3)Logistic逐步回归分析显示复发病灶个数、复发部位、复发后伴有腹水、年龄是影响手术满意度的主要因素。   结论  多个临床病理因素影响复发卵巢上皮癌手术疗效, 其中复发病灶个数、复发部位、复发后伴有腹水、年龄是影响手术满意度的主要因素。      

新辅助化疗对比初始肿瘤细胞减灭术治疗Ⅲ-Ⅳ期卵巢癌的荟萃分析

目的:比较Ⅲ-Ⅳ期卵巢癌（International Federation of Gynecology and Obstetrics,FIGO）新辅助化疗（neoadjuvant chemotherapy,NACT)联合间隔减瘤手术与初始肿瘤细胞减灭术（primary debulking surgery,PDS）联合化疗两种治疗模式有效性及安全性差异。方法:计算机检索Pubmed、Cochrane Library、Embase、Web of Science、中国生物医学文献数据库、万方数据库和中国知网等数据库,查找NACT对比PDS治疗Ⅲ-Ⅳ期卵巢癌随机对照研究相关文献,应用Review Manager 5.3软件进行统计分析。结果:纳入4项研究,共计1 631例患者。NACT组与PDS组总生存期（HR=0.95,95％CI为0.84～1.07,P=0.38）和无进展生存期相似（HR=0.97,95%CI为0.88～1.08,P＝0.61）;NACT组肿瘤完整切除率较PDS组提高（RR=2.47,95%CI为1.50～4.05,P=0.000 4）。在不良反应和安全性方面,NACT组患者≥3级静脉血栓发生率（RR＝0.25,95％CI为0.10～0.62,P=0.003）、≥3级感染发生率（RR＝0.30,95％CI为0.16～0.56,P=0.000 2）和围手术期死亡率（RR＝0.17,95％CI为0.06～0.48,P=0.000 9）均降低。结论:在Ⅲ-Ⅳ期卵巢癌治疗中,两种治疗模式生存获益相当,但新辅助化疗联合间隔减瘤手术可以提高肿瘤完整切除率,具有更好的安全性。新辅助化疗联合间隔减瘤手术可作为Ⅲ-Ⅳ期卵巢癌患者一种推荐治疗方式。     

The role of secondary cytoreductive surgery for recurrent mucinous epithelial ovarian cancer (mEOC)

Background

Mucinous epithelial ovarian cancer (mEOC) may exhibit a distinct biological behavior in epithelial ovarian cancer (EOC). The role of secondary cytoreductive surgery was evaluated in patients with recurrent mEOC, and the prognosis was assessed.

Methods

Twenty-one patients with stages IIc to IV mEOC who experienced disease recurrence and received secondary cytoreductive surgery at Fudan University Cancer Hospital between Jan. 1997 and Dec. 2005 were retrospectively reviewed. Survival curves were generated using the Kaplan–Meier method and the significant comparison of survival rate was estimated by the log-rank test.

Results

The median progression-free interval (PFI) was 14 months (range, 5–46 months) after the first cytoreduction. Seven patients (33%) who received secondary cytoreductive surgery were optimally cytoreduced with residual disease less than or equal 1 cm, and the other 14 patients (67%) underwent suboptimal surgical cytoreduction. The overall median survival time was 27 months (range, 8–64 months). The median survival time after recurrence was 10 months (range, 3–32 months). There was no significant statistical difference in median survival between patients with optimal and suboptimal secondary surgical cytoreduction, with an estimated survival of 10 months and 9.8 months, respectively (P > 0.05).

Conclusion

Optimal primary cytoreductive surgery for advanced mEOC was very important. Once it recurs, the prognosis is very poor. Patients with recurrent mEOC should be carefully assessed before performing secondary cytoreductive surgery, as this may have limited impact on the overall survival rates.     

287例盆腔及腹主动脉旁淋巴结清扫术与卵巢上皮性癌生存预后的临床分析

Objective: To evaluate the relationship between the pelvic and para-aortic lymphadenectomy and the prognosis of epithelial ovarian cancer. Methods: 287 patients suffering from primary epithelial ovarian cancer from 1995 to 2005 were analyzed retrospectively. Results: The 3-, 5-, 10-year survival with systematic lymphadenectomy (SL) were slightly higher than those without SL, but there were no statistically significance (P ＞ 0.05). The 3-, 5-, 10-year survival of clinical stages without SL were lower than those with SL, but there were no significant difference either (P ＞ 0.05). The 3-,5-, and 10-year survival rates with SL were higher than those without SL with no statistically differences (P ＞ 0.05) among the subgroups such as absent, ≤ 2 cm and ＞ 2 cm residual tumor. The survival rates of the groups without residual tumor and the group with ≤ 2cm residual tumor were significantly higher than that of ＞ 2 cm (P ＜ 0.005). On multivariate analysis, patient staging (P = 0.01)and size of residual disease after primary cytoreductive surgery (P ＜ 0.001 and = 0.002, respectively) retained prognostic significance. SL was not proved to be an independent prognostic factor (P = 0.69). Conclusion: Systematic pelvic and paraaortic lymphadenectomy can not improve and prolong the survival time significantly.     

Secondary cytoreductive surgery for isolated lymph node recurrence of epithelial ovarian cancer: A multicenter study

Introduction

Chemotherapy is the standard treatment of recurrent epithelial ovarian cancer (EOC), but its use in nodal relapses is still debated. On the other hand, the role of secondary cytoreductive surgery (SCS) remains controversial. Aim of this study is to evaluate feasibility and outcomes of SCS for the specific setting of recurrent ovarian cancer, exclusively relapsing in lymph nodes.

Patients and methods

We conducted a retrospective analysis in five Italian Institutions (University of Torino, INT of Milano, CRO of Aviano, University of Pisa and INT of Napoli) from 2000 to 2012. Patients with EOC who underwent secondary surgery for isolated lymph node recurrence (ILNR) were selected.

Results

Seventy-three patients were identified. At first diagnosis, patients received debulking surgery and platinum-based chemotherapy. The median disease free interval from completion of primary chemotherapy to nodal recurrence was 18 months. Nodal recurrence was para-aortic in 37 patients (50.7%), pelvic in 21 (28.8%), pelvic and para-aortic in 9 (12.3%), pelvic and inguinal in 3 (4.1%) and inguinal in 3 (4.1%). During SCS, in 1 patients nephrectomy was necessary for renal vein injury. No significant postoperative morbidity occurred. Median follow-up is 50 months. After secondary surgery, 32 (43.8%) are alive without disease, 18 (24.6%) are alive with disease and 23 patients (31.5%) are dead of disease. Five-year overall survival from the time of treatment of recurrent disease is 64%.

Conclusions

Secondary surgery for ILNR of ovarian cancer is feasible, safe, with low morbidity and it is associated with a favorable outcome.     

上皮性卵巢癌生化复发的判定、随访及治疗研究进展

在随访上皮性卵巢癌（epithelial ovarian cancer,EOC）患者的过程中,有相当一部分患者在首次治疗结束后会经历症状体格检查、影像学检查无复发迹象,而肿瘤标志物水平明显增高的阶段。有学者认为可将此阶段描述为“生化复发”。但是肿瘤标志物界定阈值不明确,种类繁多,因此目前尚无定论。这种状况在一定程度上影响了对这一阶段患者的随访方案的制定、治疗方法的研究。本文就上皮性卵巢癌“生化复发”的标志物阈值、检测时间、排除临床复发的方法等相关问题进行综述。     

Long-term survival of young women receiving fertility-sparing surgery for ovarian cancer in comparison with those undergoing radical surgery

Objectives:

To compare the clinical outcome of patients with stage I epithelial ovarian cancer (EOC) who received with fertility-sparing surgery (FSS) with those who underwent radical surgery (RS).

Methods:

After a central pathological review and search of the medical records from multiple institutions, a total of 572 patients were retrospectively evaluated. All patients were divided into three groups: group A {FSS (n=74); age, ⩽40} groups B and C [RS; age, 40⩾{(B), n=52} 40<{(C), n=446}].

Results:

Five-year overall survival (OS) and disease-free survival (DFS) rates of patients in the groups were as follows: group A, 90.8% (OS)/87.9% (DFS); group B, 88.3% (OS)/84.4% (DFS); group C, 90.6% (OS)/85.3% (DFS), respectively (OS, P=0.802; DFS, P=0.765). Additionally, there was no significant difference in OS and DFS among the three groups stratified to stage IA or IC (OS (IA), P=0.387; DFS (IA), P=0.314; OS (IC), P=0.993; DFS (IC), P=0.990, respectively). Furthermore, patients with a grade 1–2 or 3 tumours in the FSS group did not have a poorer prognosis than those in the RS group.

Conclusions:

Stage I EOC patients treated with FSS showed an acceptable prognosis compared with those who underwent RS.     

上皮性卵巢癌初次肿瘤细胞减灭术后复发情况及影响因素分析

目的:研究上皮性卵巢癌初次肿瘤细胞减灭术后复发情况以及影响因素分析,旨在为降低上皮性卵巢癌初次肿瘤细胞减灭术后复发提高患者术后生存质量提供有效的理论依据。方法:采用回顾性方法分析我院在2008年1月至2012年12月期间进行肿瘤细胞减灭术治疗的186例上皮性卵巢癌患者的临床资料,术后根据患者复发情况将患者分成复发组与未复发组。观察两组患者年龄、组织学类型、化疗方式、新辅助化疗、临床分期、组织分级、残余病灶、腹水、术前HE4、术后2月CA125、淋巴结切除之间的差异,同时分析影响上皮性卵巢癌初次肿瘤细胞减灭术后复发的独立危险因素。结果:随访5年,复发患者有78例,复发率为41.94%,未复发患者108例;复发组与未复发组患者在年龄、组织学类型、化疗方式、新辅助化疗等因素中比较无差异（P＞0.05）,在临床分期、组织分级、残余病灶、腹水、术前HE4、术后2月CA125、淋巴结切除中存在明显差异（P＜0.05）;经Logistic回顾分析证明,临床分期、残余病灶、腹水、术前HE4、淋巴结切除是临床上皮性卵巢癌患者初次肿瘤细胞减灭术后复发的独立危险因素［OR=9.786（3.484~27.493）、OR=8.199（4.431 ~15.172）、OR=9.143（3.975~21.031）、OR=9.337（4.593~18.983）、OR=11.917（6.440~22.053）］。结论:上皮性卵巢癌患者经初次肿瘤细胞减灭术治疗后,复发率为41.94%左右,而影响患者术后复发的独立危险因素为临床分期、残余病灶、腹水、术前HE4、淋巴结切除等,临床上可针对这些因素进行干预降低临床术后复发率,提高患者生活质量。     

Epidemiology and treatment patterns of epithelial ovarian cancer

Introduction: While ovarian cancer (OC) is relatively rare, it remains one of the most fatal cancers. Lack of robust screening methods for eOC lead to detection of most cases at advanced stages, and most patients relapse following initial treatment.

Areas covered: This review summarizes epidemiology and treatment patterns of epithelial ovarian cancer (eOC). MEDLINE, EMBASE, conference proceedings, and the Cochrane Library were searched using key terms and Medical Subject Headings for ovarian cancer, treatment patterns, and epidemiology to identify articles published from 2005–2015.

Expert commentary: To improve early detection, future studies should focus on the identification of biomarkers that can detect asymptomatic disease. Following diagnosis and eventual relapse, response to first-line platinum appears to guide physicians’ choice of subsequent therapies, but we do not understand what patients ultimately receive or its relationship to categories of response to first-line platinum. Improved understanding of later-line treatment patterns, by initial response to platinum, could correlate with overall outcomes among relapsed patients and promote development of more effective treatment guidelines. Novel treatment approaches, such as immunotherapies, would fulfill a need for an effective strategy against advanced stages of OC that results in fewer toxic side effects.