综合性治疗复发性卵巢上皮性癌的疗效及预后分析

目的　探讨个体化、分阶段综合治疗复发性卵巢上皮性癌 (卵巢癌 )的疗效 ,及分析影响预后的因素。方法　对 70例卵巢癌分两个阶段进行治疗 ,第一阶段为诱导缓解治疗阶段 ,即对铂类药物敏感患者选用紫杉醇 顺铂 (TP)或卡铂 环磷酰胺 (CP)方案进行化疗 ;对铂类药物耐药患者选用紫杉醇 丝裂霉素 (TM)或足叶乙甙 丝裂霉素 (VM)二线药物化疗方案进行化疗。化疗后行二次肿瘤细胞减灭术 ,使残留癌灶直径≤ 1cm。对经化疗或合并二次肿瘤细胞减灭术获得临床缓解的患者 ,进行残留癌灶局部放疗。第二阶段为巩固治疗阶段 ,即对获得临床缓解的患者采用间断、小剂量化疗 ,在化放疗期间选用干扰素等免疫治疗。结果　 70例患者的 1～ 5年总生存率分别为 6 7%、5 1%、4 5 %、38%、32 % ,中位生存期为 38 5 7个月 ;1～ 3年无癌生存率分别为 4 1%、37%、2 4 % ,中位无癌生存期为 12 0 0个月。多因素分析结果显示 ,中位停用铂类药物治疗时间 (P <0 0 5 )、Karnofsky评分 (P <0 0 1)、残留癌灶大小 (P <0 0 1)及化疗次数 (P <0 0 5 )等 ,是卵巢癌复发后生存期的独立预后影响因素 ,而残留癌灶大小 (P <0 0 5 )及化疗次数 (P <0 0 1) ,是卵巢癌复发后无癌生存期的独立预后影响因素。结论　个体化、分阶段的综合治疗

Multidisciplinary treatment of recurrent epithelial ovarian carcinoma and prognostic analysis

Objective To investigate individualized and multi-phase management of recurrent epithelial ovarian carcinoma in order to improve survival of the patients. Methods From 1998 to 2002, 70 patients with recurrent epithelial ovarian carcinoma were enrolled in the present study. The treatments were divided into: (1) Induction of tumor remission:platinum sensitive patients were treated with paclitaxol cisplatin (TP) or carboplatin cyclophosphamide(CP)regimen; platinum resistant patients used Taxol mitomycin(TM)or etoposide mitomycin(VM)regimen. Resection of tumors was done in an attempt to reduce the residual tumor with a diameter less than 1cm. Local radiotherapy was performed for those with residual tumor and who achieved clinical response after chemotherapy or surgery. (2) Consolidation therapy: chemotherapy with lower doses was administrated after disease remission. Interferon was used as immunotherapy during chemotherapy and radiotherapy. Survial analysis was done. Results (1) The 1, 2, 3, 4, 5-year survival rates were 67%, 51%, 45%, 38%, 32% . Median survival was 38.57 months. (3)The 1,2,3-year progression-free survival rates of the research arm were 41%, 37%, 24%. Median progression-free survival was 12.00 months. (4) Multivariate analysis revealed that platinum-free interval (P<0.05), Karnofsky performance scale (P<0.01), residual disease (P<0.01) and courses of second-line chemotherapy (P<0.05) were independent prognostic factors. Residual disease (P<0.05) and courses of second-line chemotherapy (P<0.01) contributed to progression-free survival. Conclusions (Individualized and) multi-phase treatment of recurrent epithelial ovarian carcinoma is efficacious. Optimal second cytoreduction and second-line chemotherapy are beneficial to improve the survival.