复发性卵巢上皮癌再次肿瘤细胞减灭术的临床意义及影响预后的因素

目的探讨再次肿瘤细胞减灭术（secondarycytoreductivesurgery，SCS）在复发性卵巢上皮癌（简称卵巢癌）治疗中的作用及影响预后的因素。方法回顾性分析复发性卵巢癌107例，按其治疗方式分为3组：手术组（化疗＋SCS）41例，单纯化疗组47例，未治疗组19例。比较其中位生存期，分析影响预后的因素。结果手术组、单纯化疗组的中位生存时间分别为29、23个月，两组间差别有统计学意义（P〈0．05），未治疗组中位生存时间为7个月，与其他两组相比有统计学差异（P〈0．05）。在手术组中，SCS后肉眼完全切除与未完全切除的中位生存时间相比差异具有统计学意义（P〈0．05）。多变量分析中，无疾病间期（disease—freeintervals，DFI）〉12个月、单个复发灶、最大复发灶直径≤5cm，再次手术残余灶肉眼完全切除的患者中位生存期明显延长。结论满意的SCS和二线化疗均可改善患者预后；实施SCS应遵循个体化原则，筛选适当的患者，以更好地提高患者生存质量。

Clinical significance and prognostic analysis of secondary cytoreductive surgery in treatment of patients with recurrent epithelial ovarian carcinoma

Objective To investigate the role of secondary cytoreductive surgery（SCS） in the treatment of patients with recurrent ovarian cancer and to analyse the prognostic factors of SCS. Methods One hundred and seven patients with recurrent epithelial o- varian cancer were reviewed retrospectively. They were divided into three groups： 41 patients treated with secondary cytoreductive sur- gery plus chemotherapy, 47 patients treated with secondary chemotherapy alone, and 19 patients not treated. Their median survivals were compared and the prognostic factors were analyzed. Results The median survivals in surgery group and chemotherapy group were 29 and 23 months, respectively, being of statistic significance. There was significant difference between treated patients and untreated patients（ P 〈 0.05 ）. In surgery group, complete or incomplete resection was closely related to median survival （P 〈 0.05 ）. In muhivariate analysis,DFI 〉 12 months, solitary tumor, tumor size 〈5 cm, and complete resection in SCS were independently associated with median survival. Conclusions Optimal secondary cytoreduction and second - line chemotherapy contribute to survival. Treatment should not be disrupted. In order to improve the patients＇survival quality, SCS should be individualized and proper patients should be selected.