新辅助化疗对晚期上皮性卵巢癌患者预后的影响

目的 探讨新辅助化疗对Ⅲc～Ⅳ期上皮性卵巢癌患者预后的影响.方法 回顾性分析160例Ⅲc～Ⅳ期上皮性卵巢癌患者的临床病理资料,其中42例患者行新辅助化疗后再行肿瘤细胞减灭术(NAC组),118例患者先行初次肿瘤细胞减灭术(PCS)再行化疗(PCS组),比较两组患者的生存情况及与预后相关的因素.结果新辅助化疗的总有效率为69.1%.在手术时间、术中出血量和输血量等方面,NAC组与PCS组的差异无统计学意义(P＞0.05).NAC组肿瘤细胞减灭术的满意率为88.1%,明显高于PCS组(71.2%,P＜0.05).NAC组和PCS组的复发率分别为43.2%和56.0%,差异无统计学意义(P＞0.05).NAC组的中位无瘤生存时间和中位疾病无进展生存时间分别为7个月和8个月,低于PCS组的13个月和18个月(P＜0.05);但是NAC组和PCS组的中位总生存时间分别为34个月和43个月,差异无统计学意义(P＞0.05).NAC组有37例患者行满意的肿瘤细胞减灭术(OCS),中位总生存时间为34个月;PCS组有84例患者行OCS,中位总生存时间为48个月,两组差异无统计学意义(P＞0.05).结论 新辅助化疗可以提高Ⅲc-Ⅳ期上皮性卵巢癌患者肿瘤细胞减灭术的满意率,但未降低患者治疗后的复发率,也未延长患者的总生存时间.

Impact of neoadjuvant chemotherapy on the survival of patients with stage Ⅲ c and Ⅳ epithelial ovarian cancer

Objective To compare the survival of patients with stage Ⅲ c or Ⅳ epithelial ovarian cancer treated either with neoadjuvant chemotherapy(NAC)followed by eytoreductive surgery or primary eytoreductive surgery(PCS)followed by adjuvant chemotherapy.Methods The clinical and pathological data of 160 patients with stage Ⅲc or Ⅳ epithelial ovarian cancer diagnosed pathologically between 1997 and 2005 were retrospectively reviewed.Forty-two patients were treated with NAC followed by cytoreductive surgery(NAC group)and 11 8 patients with PCS followed by adjuvant chemotherapy(PCA group).Results The overall response rate of NAC group was 69.1%.No significant difierence was observed between the NAC group and PCS group in operating time,intra-operative blood loss and units of blood-transfusion (P＞0.05).Optimal cytoreductive surgery was performed in 88.1%of NAC group versus in 71.2%of PCS group(P＜0.05).In those who had optimal cytoreductive surgery,the recurrent rate was 43.2%in NAC group versus 56.0%in PCS group without significant difference between two groups(P＞0.05).The disease-free survival and progression.free survival was 7 and 8 months in NAC group.which were significantly shorter than 13 and 18 months in PCS group(P＜0.05),however,the median overall survival (OS)was 34 months in NAC group versus 43 months in PCS group without significant difference(P＞0.05).In the patients with optimal eytoreductive surgery,it was 34 months in NAC group versus 48 months in PCS group without significant difference either between two groups(P＞0.05).Conclusion Neoadjuvant chemotherapy followed by cytoreductive surgery can improve the rate of optimal cytoreductive surgery for the patients with stageⅢc orⅣepithelial ovarian cancer.but this regimen may neither reduce the recurrent rate nor prolong the survival when compared with the patients treated with primary cytoreductive surgery followed by adjuvant chemotherapy.