晚期卵巢癌新辅助化疗的疗效评估

目的 研究分析晚期卵巢癌患者实施新辅助化疗治疗的效果及影响预后的相关因素.方法 回顾性分析我院2018年1月至2019年12月期间治疗的60例已被确诊为晚期卵巢癌患者的临床资料.患者在实施新辅助化疗后,继续中间性肿瘤细胞减灭术治疗.分析新辅助化疗和中间性肿瘤细胞减灭术的治疗效果,以及影响患者预后生存期的相关因素.结果 新辅助化疗后,患者KPS评分、血红蛋白量、血清清蛋白量、腹腔镜评分、原发肿瘤最大直径、腹水量等指标均有明显改善,治疗前后具有统计学差异(P＜0.05).中间性肿瘤细胞减灭术治疗后,42例患者减瘤满意度良好.年龄、FIGO分期、减瘤满意度是影响预后的主要因素.结论 新辅助化疗治疗晚期卵巢癌患,能够达到比较理想的疗效,配合中间性肿瘤细胞减灭术治疗还能够提升患者的减瘤满意度.     

新辅助化疗联合中间性肿瘤细胞减灭术治疗晚期上皮性卵巢癌效果观察

目的探讨新辅助化疗联合中间性肿瘤细胞减灭术治疗晚期上皮性卵巢癌的疗效。方法选取晚期上皮性卵巢癌患者60例,按照随机数表法将其分为观察组及对照组,每组30例。两组患者术前均接受化疗,并在化疗3个疗程后间隔一段时间实施中间性肿瘤细胞减灭术,观察组患者术后继续接受3个疗程的新辅助化疗。比较两组疗效及不良反应。结果观察组患者治疗总有效率(83.33%)高于对照组(53.33%),差异有统计学意义(P0.05);观察组患者各不良反应发生率均高于对照组,差异有统计学意义(P0.05)。结论新辅助化疗与中间性肿瘤细胞减灭术治疗晚期上皮性卵巢癌,可提高患者近期疗效,因其不良反应有所增加,选择术后新辅助化疗方案时需考虑患者耐受情况。     

新辅助化疗联合间歇性肿瘤细胞减灭术治疗晚期卵巢癌疗效观察

目的探讨新辅助化疗联合间歇性肿瘤细胞减灭术治疗晚期卵巢癌的临床效果。方法365例晚期卵巢癌患者随机分为3组,行初次肿瘤细胞减灭术者89例为初次手术组,行间歇性肿瘤细胞减灭术者123例为间歇手术组,行新辅助化疗联合间歇性肿瘤细胞减灭术者153例为观察组,治疗结束后评价3组疗效,并随访观察3组5a生存率。结果初次手术组、间歇手术组、观察组有效率分别为16．0％、52．1％、63．4％,5a生存率分别为20．3％、30．5％、32．3％,间歇手术组、观察组高于初次手术组（P〈O．05）,间歇手术组与观察组间比较差异无统计学意义（P〉0．05）。结论新辅助化疗联合间歇性肿瘤细胞减灭术可提高晚期卵巢癌治疗有效率,改善远期预后。     

新辅助化疗 肿瘤细胞减灭术治疗晚期卵巢癌的临床意义

目的探讨新辅助化疗结合中间性肿瘤细胞减灭术治疗晚期卵巢癌的临床意义。方法回顾性分析40例晚期卵巢癌患者,按照新辅助化疗后再减瘤和直接手术减瘤分为两组,比较化疗疗效和预后。结果新辅助化疗组化疗有效率88．9％,新辅助化疗组平均术中出血量明显少于直接手术组（P〈0．05）;新辅助化疗组手术时间较直接手术组缩短,两组比较有显著性差异（P〈0．05）。新辅助化疗组满意减瘤率为83．3％,明显高于直接手术组45．5％（P〈0．05）。新辅助化疗组和直接手术组中位生存时间分别为35个月和28个月,差异无统计学意义（P〉0．05）。结论新辅助化疗结合中间性肿瘤细胞减灭术可以明显提高晚期卵巢癌患者手术满意率,但并未延长患者生存期。     

肿瘤细胞减灭术和新辅助化疗治疗晚期上皮性卵巢癌的疗效

目的:研究肿瘤细胞减灭术联合新辅助化疗治疗晚期上皮性卵巢癌的疗效及预后。方法:选取2016年2月～2017年2月收治的70例晚期上皮性卵巢癌患者作为研究对象,按照随机数字表法分为对照组和观察组各35例。对照组采用肿瘤细胞减灭术+术后化疗治疗;观察组采用肿瘤细胞减灭术联合新辅助化疗方案治疗。比较两组围手术期各项指标、术后1年和2年的生存率以及不良反应发生情况。结果:观察组围手术期的各项指标均少于对照组,差异有统计学意义,P0.05;观察组术后1年和2年的生存率均高于对照组,差异有统计学意义,P0.05;两组不良反应发生率比较,差异无统计学意义,P0.05。结论:新辅助化疗联合肿瘤细胞减灭术治疗晚期上皮性卵巢癌疗效显著,患者术后生存率高。     

晚期上皮性卵巢癌腹膜后淋巴结清扫的临床价值

目的评价腹膜后淋巴结清扫对晚期上皮性卵巢癌预后的影响。方法将67例晚期上皮性卵巢癌患者随机分为研究组32例及对照组35例。研究组行卵巢肿瘤细胞减灭术+术后规范化疗,对照组行卵巢肿瘤细胞减灭术+腹膜后淋巴结清扫术+术后规范化疗,对比2组手术时间、术中出血量、术后病率及术后1、3、5年生存率的差异。结果研究组术中出血量、手术时间、术后病率均显著小于对照组。2组1、3、5年生存率均无显著差异;而2组术后残留癌灶<1.0 cm的患者3、5年生存率均显著高于同组残留癌灶≥1.0 cm的患者。结论理想的肿瘤减灭术是影响晚期上皮性卵巢癌患者预后的重要因素,而腹膜后淋巴结清扫不能提高晚期上皮性卵巢癌的生存率,反而使围手术期的并发症显著提高。     

复发卵巢癌再次细胞减灭术的价值

原发性卵巢癌标准治疗方案是初次肿瘤细胞减灭术和以顺铂为基础的联合化疗。理想的初次肿瘤细胞减灭术能暂时阻断肿瘤的自然进程并提高对一线化疗的敏感性,从而提高5年生存率。但晚期卵巢癌(Ⅲ～Ⅳ期)患者,经过首次系统治疗,临床症状消失,且体格、血清学和影像学检查全部阴性者,复发率仍>80%[1]。卵巢癌的复发是当今治疗的难点之一,再次手术对复发卵巢癌是否有积极的治疗价值尚有不同的观点。本文将综述复发卵巢癌的临床特点,复发卵巢癌手术的理论基础和手术范围,以及手术的临床价值及对预后的影响。1复发卵巢癌的部位及特点卵巢癌患者在接…     

新辅助化疗对晚期卵巢癌的疗效分析

目的 探讨提高晚期卵巢癌疗效的方法.方法 45例Ⅲ、Ⅳ期卵巢癌患者,其中21例(NACT组)采用新辅助化疗+肿瘤细胞减灭术,24例(ACT组)采用常规的肿瘤细胞减灭术及术后辅助化疗.结果 NACT组术前症状有效缓解18例(85.7%),15例获最佳减灭,占71.3%;ACT组10例获最佳减灭,占41.7%:两组比较差异有统计学意义(P<0.05).1年生存率NACT组明显优于ACT组(80.9%vs 58.3%,P<0.05),3年生存率两组比较差异无统计学意义(38.4%vs 37.5%,P0.05).结论 NACT可提高减灭术的成功率及1年生存率.对远期生存率尚需继续观察.     

腹腔镜下卵巢癌减灭术治疗卵巢癌的疗效观察

目的探讨腹腔镜下卵巢癌减灭术治疗卵巢癌的临床疗效。方法回顾性分析2016年8月～2019年9月我院收治的晚期卵巢癌患者91例的临床资料,根据术式的不同分为观察组46例和对照组45例。对照组行开腹式卵巢癌减灭术,观察组行腹腔镜下卵巢癌减灭术。对比两组围手术期指标、身体状况、生活质量及并发症情况。结果观察组手术时间、术中出血量、术后引流量、术后排气时间、VAS评分、肠胃功能恢复时间、住院时间均低于对照组,淋巴结切除数目高于对照组,差异有统计学意义(P<0.05);术后2个月,两组KPS评分低于术前,SF-36高于术前,但观察组上述评分均优于对照组,差异有统计学意义(P<0.05);两组并发症发生率对比,差异无统计学意义(P>0.05)。结论实施腹腔镜卵巢癌减灭术与开腹式手术相比,可减轻机体创伤性,缩短术后恢复时间,且并发症发生率较少,可改善患者身体状况,提升生活质量。     

Ki-67对晚期卵巢癌患者肿瘤细胞减灭术后复发转移的预测价值

目的 探讨Ki-67对晚期卵巢癌患者肿瘤细胞减灭术后复发转移的预测价值。方法 共纳入109例晚期卵巢癌,均接受肿瘤细胞减灭术,根据术后免疫组织化学染色Ki-67表达状态分为Ki-67阳性组57例和Ki-67阴性组52例,比较2组一般临床病理资料,运用多因素Cox回归分析获得晚期卵巢癌患者肿瘤细胞减灭术后复发转移的影响因素,采用Kaplan-Meier生存曲线分析2组术后5年无病生存率,并绘制预测晚期卵巢癌患者肿瘤细胞减灭术后复发转移的决策曲线。结果 2组癌抗原125(CA125)、临床分期、淋巴结转移、腹膜转移、脉管浸润、分化程度及肿瘤大小比较差异有统计学意义(P<0.05,P<0.01)。多因素Cox回归分析结果显示,CA125、临床分期、腹膜转移及Ki-67表达为晚期卵巢癌患者肿瘤细胞减灭术后复发转移的独立危险因素(P<0.05,P<0.01),其中Ki-67阳性表达患者肿瘤细胞减灭术后复发转移的风险是Ki-67阴性表达患者的3.896倍。Kaplan-Meier生存曲线显示,Ki-67阴性组术后1、3、5年无病生存率明显高于Ki-67阳性组(P<0....     

磁共振扩散加权成像对晚期卵巢癌患者腹膜癌指数预测的可行性研究

目的 评估磁共振扩散加权成像(diffusion weighted imaging,DWI)预测晚期卵巢癌患者腹膜癌指数(peritoneal cancer index,PCI)的潜力,以及预测患者能否行完全肿瘤细胞减灭术.材料与方法 回顾性研究2016年6月至2018年5月在丹东市中医院接受肿瘤细胞减灭术治疗的25例...     

二次肿瘤细胞减灭术在复发性上皮性卵巢癌中的作用

目的评价二次肿瘤细胞减灭术对复发性上皮性卵巢癌患者治疗的临床意义。方法回顾性分析了本院1998～2005年间收治的52例复发性上皮性卵巢癌患者的临床资料。24例接受了二次肿瘤细胞减灭术(手术组),术后辅以铂类为基础的化疗。另外28例患者只接受了以铂类为基础的化疗(对照组)。结果手术组患者复发后中位生存期为32.5个月,对照组中位生存期为18.4个月,差异有统计学意义(P<0.05)。手术组中,生存期受手术后残余病灶的影响,残余病灶直径<2cm,中位生存期为41.3个月,残余病灶直径>2cm,中位生存期为28.5个月,差异有统计学意义(P<0.05)。结论二次肿瘤细胞减灭术可以改善复发性上皮性卵巢癌患者的预后。     

Primary cytoreductive surgery for advanced ovarian cancer: is it the past, present, or future?

Ovarian cancer accounts for more deaths in the United States than all other gynecologic malignancies combined. This is largely due to the fact that no effective screening test has been identified thus far to facilitate early detection. As a result, two-thirds of women continue to be diagnosed with advanced stage III or IV disease. Historically, the standard of care has consisted of primary cytoreductive surgery-with an operative goal of achieving an optimal result with minimal residual disease-followed by adjuvant, platinum-based chemotherapy. However, data suggesting comparable efficacy of neoadjuvant chemotherapy and interval debulking has recently challenged this conventional dogma. The current decision-making on how to initially treat women with newly diagnosed advanced ovarian cancer has become increasingly controversial. This article focuses on whether primary cytoreductive surgery should remain the preferred method of management, or whether it is time for it to be superseded by neoadjuvant chemotherapy.     

Current management strategies for ovarian cancer

Epithelial ovarian cancer originates in the layer of cells that covers the surface of the ovaries. The disease spreads readily throughout the peritoneal cavity and to the lymphatics, often before causing symptoms. Of the cancers unique to women, ovarian cancer has the highest mortality rate. Most women are diagnosed as having advanced stage disease, and efforts to develop new screening approaches for ovarian cancer are a high priority. Optimal treatment of ovarian cancer begins with optimal cytoreductive surgery followed by combination chemotherapy. Ovarian cancer, even in advanced stages, is sensitive to a variety of chemotherapeutics. Although improved chemotherapy has increased 5-year survival rates, overall survival gains have been limited because of our inability to eradicate all disease. Technologic advances that allow us to examine the molecular machinery that drives ovarian cancer cells have helped to identify numerous therapeutic targets within these cells. In this review, we provide an overview of ovarian cancer with particular emphasis on recent advances in operative management and systemic therapies.     

Adjuvant systemic chemotherapy with gemcitabine for stage IV pancreatic cancer: a preliminary report of initial experience

BACKGROUND: The effects of gemcitabine on postoperative adjuvant chemotherapy were evaluated in patients with stage IV pancreatic cancer. The results were compared with those of our historical control patients treated with surgery alone. PATIENTS AND METHODS: Nineteen patients with stage IV pancreatic cancer who had pancreatic resection with curative intent during the 5 years up to February 2003 were enrolled in this study. Nine cases received postoperative adjuvant chemotherapy with biweekly administration of 1,000 mg/m(2) gemcitabine, while the remaining 10 cases underwent surgery without any adjuvant chemotherapy. Results: The chemotherapy was well tolerated with only mild symptomatic and hematologic toxicities. The disease-specific cumulative survival rates of the chemotherapy and surgery-alone groups were 86 and 70% at 1 year, and 50 and 12% at 2 years, with a median survival of 20 and 14 months, respectively (p = 0.0255). The disease-free interval was improved, and the occurrence of hepatic metastasis was reduced in the chemotherapy group compared with the surgery-alone group. CONCLUSIONS: Adjuvant systemic chemotherapy utilizing gemcitabine was feasible with acceptable adverse effects, and showed some survival benefit in stage IV pancreatic cancer patients. Further investigation into gemcitabine-based combination therapies is warranted.     

肿瘤细胞减灭术在晚期子宫内膜癌治疗中作用

目的目前晚期子宫内膜癌患者生存率低、生活质量差，治疗无定规方案。为探讨其治疗。方法对我院7年来36例晚期子宫内膜癌患者临床资料进行回顾性分析。Ⅲ期16例，Ⅳ期20例。所有患者均给予以手术治疗为主的综合治疗，基本手术方式为广泛全子宫切除＋双附件＋大网膜、阑尾切除及盆、腹腔内转移病灶切除。结果本组肉眼无残余病灶者10例，残余病灶〈2cm者20例，残余病灶〉2cm者6例，手术满意率为83.3％（30／36）。随访至2008年12月，5年生存率仅为31．3％（5／16），3年生存率为54．2％（13／24），1年生存率为91．7％（33／36）。生存率与患者病变侵及范围、有无腹水、手术后残留病灶大小以及术后化疗周期长短等密切相关。结论初步研究结果提示，提倡最大限度切除病灶减少肿瘤负荷，在理想的肿瘤细胞减灭术的基础上给予多疗程的联合化疗，而放射治疗的临床作用尚需进一步探讨。表明肿瘤细胞减灭术在晚期子宫内膜癌治疗中有重要价值。     

The association between allogeneic perioperative blood transfusion on tumour recurrence and survival in patients with advanced ovarian cancer

Objective: To evaluate the association between perioperative blood transfusion on the recurrence and survival of patient with advanced ovarian cancer. Background: Cytoreductive surgery for ovarian cancer can be an extensive procedure often requiring allogeneic blood transfusions. Blood transfusions can have detrimental effects on immune function which can lead to a decrease in the organism ability to detect and destroy metastasis. Methods: The study was a retrospective cohort investigation. Patients with advanced ovarian cancer (stage III) undergoing cytoreductive surgery were stratified by the need for perioperative blood transfusion. Allogeneic transfusions were non‐leucodepleted. Primary outcome included time to recurrence and survival. Data were extracted from the gynaecology oncology database at Northwestern University. Times to event outcomes were evaluated by constructing Kaplan–Meyer curves and Cox regression. Results: The charts of 136 subjects were evaluated. Seventy‐six received blood transfusion. Median [95% confidence interval (CI)] time to recurrence for the non‐transfusion group was longer, i.e. 17 (6–27) months, compared to 11 (8–14) months for the transfused group (P = 0·03). Median (95% CI) survival following surgery was longer in the non‐transfused group, i.e. 58 (43–73) months, compared to 36 (28–44) months for the transfused group (P = 0·04). Cox regression showed that transfused subjects had shorter median times to recurrence and mortality after adjusting for age and tumour grade. Conclusions: There is an association between ovarian cancer recurrence and allogeneic perioperative blood transfusion in patients with advanced ovarian cancer undergoing cytoreductive surgery. These findings may have important implications in the perioperative management of those patients.     

晚期上皮性卵巢癌、输卵管癌、原发性腹膜癌患者新辅助化疗后Ki-67表达与预后的相关性分析

目的分析晚期上皮性卵巢癌、输卵管癌、原发性腹膜癌患者新辅助化疗后Ki-67水平与患者预后的关系。方法回顾性收集重庆医科大学附属第一医院2017年1月至2019年6月接受新辅助化疗联合间期肿瘤细胞减灭术的晚期上皮性卵巢癌、输卵管癌、原发性腹膜癌患者的病历资料,对其临床病理特征、术后病理标本中卵巢癌组织Ki-67表达情况及患者无进展生存期进行统计分析。结果根据时间依赖的受试者工作特征曲线(ROC曲线)分析,判断患者预后情况的Ki-67最佳临界值为20%。单因素分析显示,新辅助化疗后Ki-67≥20%的患者无进展生存期短于Ki-67<20%的患者,差异有统计学意义(P<0.05);在除外分期、肿瘤分级、原发部位、手术方式及手术结局等因素的作用后,Ki-67为患者无进展生存期的独立影响因素(P=0.004,HR=1.927,95%CI:1.240~2.995)。结论新辅助化疗后Ki-67水平是晚期上皮性卵巢癌、输卵管癌、原发性腹膜癌患者复发的独立影响因素,Ki-67≥20%的患者可能倾向于早期复发。     

人附睾蛋白4在上皮性卵巢癌中的应用价值

近年来卵巢恶性肿瘤的发病率逐年升高并趋于年轻化。上皮性卵巢癌因早期常无明显症状,亦无有效监测手段,故多于晚期发现,预后较差。即使通过规范的手术及化疗,晚期上皮性卵巢癌的5年生存率为20%~30%,而早期上皮性卵巢癌(I~II期)患者5年生存率可达90%。上皮性卵巢癌患者的生存率与其分期及治疗效果相关。临床上一直在探索一种有效的监测手段,以期早期诊断并准确评估晚期上皮性卵巢癌的治疗效果,从而提高患者的生存率。人附睾蛋白4(human epididymis protein 4,HE4)作为近年来新发现的肿瘤标志物,在正常组织中呈限制性表达,在良性肿瘤组织中表达水平较低,在上皮性卵巢癌组织及血清中呈高水平表达。多项研究表明,HE4在早期上皮性卵巢癌的诊断、卵巢癌治疗效果及预后中有一定的应用价值。