晚期卵巢上皮性癌的综合治疗和预后分析

目的：对晚期卵巢上皮性癌的综合治疗进行研究,并对其预后因素加以分析,方法：选择复旦大学附属肿瘤医院1998年1月至2000年12月收治的晚期卵巢上皮性癌患者53例（研究组）,给予综合治疗即诱导缓解,巩固治疗和免疫支持治疗,另选择1986年1月至1997年、12月间收治的晚期卵巢上皮性癌患者318例（对照组）,给予肿瘤细胞减灭术及常规化学药物治疗（化疗）。结果：研究组的完全缓解率,部分缓解率分别为90．6％,5．7％,均明显高于对照组的70．1％,5．3％（P＜0．01）,研究组的1,2,3年生存率分别为97．7％,89．1％,83．6％,均明显高于对照组的71．8％,44．1％,29．8％（P＜0．01）,研究组的1,2,3年无癌生存率分别为92．6％,70％,75．0％,均明显高于对照组的60．3％,37．8％,28．6％（P＜0．01）,研究组1,2年的肿瘤复发率分别为7．5％,25．0％,均明显低于对照组的39．7％,62．2％（P＜0．01）,和预后有关的因素有年龄,首治医院,手术病理分期,腹水,病理分化程度,术前化疗,术后腹腔化疗和静脉化疗,和无癌生存相关的预后因素是首治医院,卵巢侵犯程度,残留癌直径大小和术后腹腔化疗,结论：通过诱导缓解,巩固治疗和免疫支持治疗可提高疗效,明显降低了晚期卵巢上皮性癌的1,2年复发率,提高了晚期上皮性癌的生存率。

Combined treatment and prognostic analysis of advanced epithelial ovarian carcinoma

Objective To evaluate the effects of combined treatment for advanced epithelial ovarian carcinoma and to analyze its prognostic factors Methods Fifty three patients treated with a three step combined therapeutic regimen were defined as research arm The procedures of the three step combined treatment were as follows: induction of tumor remission, sequential chemotherapy and adjuvant immunotherapy Three hundred and eighteen patients with advanced epithelial ovarian carcinoma treated with cytoreductive surgery and systemic chemotherapy were retrospectively classified into control arm Results The rates of complete response and partial response in the research arm were significantly differed from those in the control arm (90 6%, 5 7% Vs 70 1%, 5 3%, P <0 01) The 1 , 2 and 3 year survival rates of the research arm and control arm were 97 7%, 89 1%, 83 6% Vs 71 8%, 44 1%, 29 8%, respectively ( P <0 01) The 1 , 2 and 3 year tumor free survival rates of the research arm and control arm were 92 6%, 75 0%, 75 0% Vs 60 3%, 37 8%, 28 6%, respectively ( P <0 01) The 1 and 2 year recurrent rates of the patients in research arm were much lower than that in control arm (7 5%, 25 0% Vs 39 7%, 62 2%, P <0 01) Age, stage, ascites, differential degree, preoperative chemotherapy (intraperitoneal and/or intravenous chemotherapy), postoperative intraperitoneal chemotherapy and systemic chemotherapy were poor prognostic factors Initially treated in other hospital, bilateral tumors, large residuals (diameter more than 1cm) and postoperative intraperitoneal chemotherapy were poor tumor free survival prognostic factors Conclusion Combined therapy including remission induction, consolidation chemotherapy and immunotherapy was able to enhance therapeutic efficacy, decrease the 1 and 2 year recurrent rate and improve the survival of patients with advanced epithelial ovarian carcinoma