铂类化疗敏感型卵巢上皮癌复发的影响因素

背景与目的:卵巢癌患者中对铂类化疗敏感者较耐药者预后好,但是铂类化疗敏感型卵巢上皮癌患者中仍有较高的复发率,从而影响此类患者的预后。本研究旨在总结对铂类化疗敏感型卵巢上皮癌患者的临床特点,探讨影响其复发的因素。方法:回顾性分析和总结1993～1999年中山大学肿瘤防治中心收治的90例临床完全缓解超过6个月以上的对铂类化疗敏感型卵巢上皮癌患者复发的影响因素。复发相关的单因素分析采用χ2检验,多因素分析采用Cox模型。结果:90例卵巢上皮癌患者中出现复发者36例,复发率为40.0%,中位复发时间20个月。复发的部位以盆腔最多,占50.0%(18/36)。90例患者总的3年、5年生存率分别为79.6%、69.5%。36例复发患者3年、5年生存率分别为62.3%、39.6%。单因素分析显示铂类化疗敏感型卵巢上皮癌中FIGO分期早、无新辅助化疗、粘液性癌者复发风险低(P=0.001,P=0.002和P=0.025)。经Cox多因素分析显示仅FIGO分期是肿瘤复发的独立危险因子(RR=1.771,P=0.003)。术后采用CBP和铂类其它组合的方案化疗对铂类化疗敏感型卵巢上皮癌复发的影响差异无显著性,过多疗程的术后化疗并不能减少复发。结论:FIGO分期是影响铂类化疗敏感型卵巢上皮癌复发的显著因素,早期诊断对于降低复发十分重要。

Recurrence risk factors of platinum-sensitive epithelial ovarian cancer

BACKGROUND & OBJECTIVE: The prognosis of platinum-sensitive ovarian cancer patients was better than that of chemoresistant ones. However, platinum-sensitive ovarian cancer patients still have a high recurrence rate, which affects their prognosis. This study was designed to analyze clinical features and recurrence risk factors of platinum-sensitive epithelial ovarian cancer. METHODS: Factors that might relate to recurrence of 90 platinum-sensitive epithelial ovarian cancer patients, admitted in Cancer Center of Sun Yat-sen University from 1993 to 1999, with complete remission of more than 6 months, were assessed. Univariate analysis was performed using Chi(2) test; while multivariate analysis was carried out using Cox proportional hazard model. RESULTS: Among the 90 patients, 36(40.0%) relapsed with the median recurrence-free interval of 20 months. Pelvic cavity (18/36, 50.0%) was the most frequently involved. The 3-and 5-year survival rates of all patients were 79.6% and 69.5%; while those of the recurrent ones were 62.3% and 39.6%. Univariate analysis showed that the early FIGO stage group, mucinous type group, and no neoadjuvant chemotherapy group had lower recurrence rates than advanced FIGO stage group, non-mucinous type group, and neoadjuvant chemotherapy group, respectively (P=0.001, P=0.002, and P=0.025). Cox multivariate analysis showed that only FIGO stage was the independent risk factor of recurrence of ovarian cancer (risk ratio=1.771, P=0.003). There was no significant difference in recurrence rate between CBP and other postoperative chemotherapy regimen groups. More cycles of chemotherapy could not reduce the recurrence rate. CONCLUSION: Since FIGO stage is an independent recurrence risk factor of platinum-sensitive epithelial ovarian cancer patients, early diagnosis is the key point to decrease the recurrence rate.