| Yinghui Li,Shaojia Wang,Linlin Yang,Chunmei Yin,Hongying Yang. A retrospective clinical study of neoadjuvant chemotherapy for advanced epithelial ovarian cancer. Oncol Transl Med, 2017, 3: 231-240. |
| 晚期上皮性卵巢癌新辅助化疗的回顾性临床研究 |
| A retrospective clinical study of neoadjuvant chemotherapy for advanced epithelial ovarian cancer |
| Received:October 09, 2017 Revised:November 15, 2017 |
| DOI： 10.1007/s10330-017-0241-1 |
| 中文关键词: 新辅助化疗;晚期上皮性卵巢癌; 肿瘤细胞减灭术；预后影响因素。 |
| 英文关键词: neoadjuvant chemotherapy (NACT); advanced epithelial ovarian cancer (EOC); cytoreduction surgery; prognostic factors |
| 基金项目: |
| Author Name | Affiliation | E-mail | | Yinghui Li | Yunnan Cancer Hospital & The Third Affiliated Hospital of Kunming Medical University & Yunnan Cancer Center, Kunming 650000, China | 742919339@qq.com | | Shaojia Wang | Yunnan Cancer Hospital DdDd The Third Affiliated Hospital of Kunming Medical University DdDd Yunnan Cancer Center, Kunming 650000, China | | | Linlin Yang | Yunnan Cancer Hospital DdDd The Third Affiliated Hospital of Kunming Medical University DdDd Yunnan Cancer Center, Kunming 650000, China | | | Chunmei Yin | Yunnan Cancer Hospital DdDd The Third Affiliated Hospital of Kunming Medical University DdDd Yunnan Cancer Center, Kunming 650000, China | | | Hongying Yang* | Yunnan Cancer Hospital DdDd The Third Affiliated Hospital of Kunming Medical University DdDd Yunnan Cancer Center, Kunming 650000, China | jyahy@tom.com |
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| 中文摘要: |
| 摘要
【目 的】1.探讨新辅助化疗(NACT)治疗晚期上皮性卵巢癌（EOC）的临床疗效。
2.分析晚期卵巢上皮性癌的预后影响因素。
【方 法】选取2006年10 月至2015年12月首诊于云南省肿瘤医院(昆明医科大学第三附属医院)的241例III、IV期上皮性卵巢癌患者。观察组(NACT-IDS组)(n=119)给予以铂类为基础1-3疗程新辅助化疗+肿瘤细胞减灭术+术后6-8疗程化疗，对照组（PDS组）(n=122）直接给予初次肿瘤细胞减灭术+术后6-8疗程化疗。
【结 果】
1.NACT-IDS组手术时间、术中出血量、手术住院天数明显少于PDS组，差异有统计学意义(P<0.05 )。
2.NACT-IDS组理想减灭率高于PDS组，差异有统计学意义（P＜0.05）。NACT-IDS组、PDS组无肉眼可见残留病灶比例分别为49例（41.18%）、48例（40%），差异无统计学意义（P＞0.05）。
3.NACT-IDS组的IV期患者明显高于PDS组，差异有统计学意义（P＜0.05）。观察至随访时间，NACT-IDS组复发率高于PDS组，差异有统计学意义(P＜0.05 )。NACT-IDS组、PDS组死亡率为45.19％(47/104例)、35.19％(38/108例)，差异无统计学意义（P＞0.05）。NACT-IDS组、PDS组的无进展生存期分别为23.75±9.98个月和23.57±12.25个月，差异无统计学意义(P > 0.05 )。NACT-IDS组、PDS组总生存期分别为31.11±15.66个月和29.63±18.00个月，差异无统计学意义(P >0.05)。
4.单因素分析：无肉眼可见残留病灶、术后残余病灶大小、术后化疗周期数与晚期EOC的OS有相关性（P＜0.05）。组织病理学类型、无肉眼可见残留病灶、术后化疗周期数与晚期EOC的PFS有相关性（P＜0.05）。
5.多因素分析显示：术后无肉眼可见病灶是晚期卵巢上皮性癌OS的独立影响因素（P＜0.05）；
6.总化疗周期数≥8疗程的总生存期优于＜8疗程者，≥6疗程的总生存期优于＜6疗程，差异有统计学意义（P＜0.05）。
【结 论】
1.NACT能够改善晚期卵巢上皮性癌的手术情况。
2.NACT-IDS组IV期患者明显高于PDS组，但两组的PFS、OS、死亡率并没有明显的差异，提示新辅助化疗提高了晚期EOC的临床治疗效果。
3.达到无肉眼所见残留病灶对于晚期EOC患者远期疗效是保护因素。
4.总化疗周期数≥8疗程或者术后化疗周期数≥6疗程可以改善晚期EOC的OS。 |
| 英文摘要: |
| Objective The aim of this study was to investigate the clinical efficacy of neoadjuvant chemotherapy
(NACT) and the prognostic factors for advanced epithelial ovarian cancer (EOC).
Methods We enrolled 241 patients with stage III and IV EOC who were diagnosed at the Yunnan
Cancer Hospital between October 2006 and December 2015. The observation (NACT-IDS) group (n =
119) received 1–3 courses of platinum-based NACT, followed by interval debulking surgery (IDS) and 6–8
courses of postoperative chemotherapy. The control group underwent primary debulking surgery (PDS) (n
= 122) followed by 6–8 courses of postoperative chemotherapy. We analyzed the general conditions of the
operations and the survival of both groups.
Results Operating time, intraoperative blood loss and postoperative hospitalization were significantly
lower in the NACT-IDS group (P < 0.05). The rate of optimal cytoreductive surgery was significantly higher
in the NACT-IDS group (P < 0.05). A visible residual lesion was observed in 49 (41.18%) and 48 (40%)
cases in the NACT-IDS and PDS groups, respectively, which were not significantly different (P > 0.05).
The percentage of International Federation of Gynecology and Obstetrics (FIGO) stage IV tumors and
the recurrence rates were significantly higher in the NACT-IDS group (P < 0.05). The mortality rates
were 45.19% (47/104) and 35.19% (38/108) in the NACT-IDS and PDS groups, respectively (P > 0.05).
Progression-free survival was 23.75 ± 9.98 and 23.57 ± 12.25 months in the NACT-IDS and PDS groups,
respectively (P > 0.05). Overall survival (OS) was 31.11 ± 15.66 and 29.63 ± 18.00 months in the NACTIDS
and PDS groups, respectively (P > 0.05). Optimal cytoreductive surgery with or without residual lesion
was an independent influencing factor for advanced EOC in multivariate analysis. OS of patients treated
with ≥8 courses of chemotherapy was significantly longer than those treated with < 8 courses.
Conclusion NACT could improve the intra- and postoperative conditions in advanced EOC patients.
Although the percentage of FIGO stage IV cancer was significantly higher in the NACT-IDS group, the
prognosis was similar in both the NACT-IDS and PDS groups, suggesting that NACT improves the clinical
outcome of advanced EOC. Optimal cytoreductive surgery with no residual lesion is a long-term protective
factor in advanced EOC. At least 8 courses of chemotherapy overall or ≥ 6 courses postoperatively
improves the OS. |
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