叶少芬,陈亚侠.晚期卵巢癌初始治疗结局及影响因素:基于453例患者的分析[J].肿瘤学杂志,2022,28(7):551-556.
晚期卵巢癌初始治疗结局及影响因素:基于453例患者的分析
Outcome and Influencing Factor of Patient with Advanced Epithelial Ovarian Cancer Following Primary Resection Based on Analysis of 453 Cases
投稿时间:2022-01-09  
DOI:10.11735/j.issn.1671-170X.2022.07.B004
中文关键词:  卵巢癌  初始治疗  完全缓解  影响因素
英文关键词:ovarian cancer  primary treatment  complete remission  influencing factor
基金项目:
作者单位
叶少芬 浙江大学医学院附属妇产科医院 
陈亚侠 浙江大学医学院附属妇产科医院 
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中文摘要:
      摘 要:[目的] 探讨FIGO Ⅲ、Ⅳ期上皮性卵巢癌患者初始治疗的临床结局及相关影响因素。[方法] 纳入2002年1月至2019年12月在浙江大学医学院附属妇产科医院进行初始治疗的453例Ⅲ、Ⅳ期卵巢癌患者,根据初治结局分为完全缓解组和非完全缓解组,评价术后残余病灶、腹水量等因素对初始治疗结局能否达到CR的影响。[结果] 177例(39.1%)达到R0切除,358例(79.0%)初始治疗结局为CR。单因素分析显示,手术时长、腹腔积液量、分期、组织学级别、组织学类型、血清CA125初始水平、CA125正常化所需的化疗周期数、淋巴结转移总枚数、术后残余病灶大小、是否为TP化疗方案是影响初始治疗结局的相关因素。多因素分析显示,透明细胞癌(OR=0.043,95%CI:0.007~0.248)、术后残余病灶较大(0~1 cm vs R0,OR=0.346,95%CI:0.153~0.784;≥1 cm vs R0,OR=0.269,95%CI:0.120~0.604)、CA125正常化需要较多的化疗周期数(3~4 vs 0~2,OR=0.413,95%CI:0.194~0.882;≥5 vs 0~2,OR=0.077,95%CI:0.035~0.169)不利于达到CR,高级别病变(G3,OR=2.677,95%CI:1.162~6.163)、TP方案化疗(OR=2.571,95%CI:1.170~5.651)有利于达到CR。[结论] 透明细胞癌、CA125正常化需化疗多于4个周期、非R0手术、非TP方案化疗的患者需引起重视,早诊断、满意减瘤、CA125回降不佳时及时调整治疗方案可提高初始治疗有效率。
英文摘要:
      Abstract:[Objective] To analyze the clinical outcome and influencing factor of advanced epithelial ovarian cancer patients after primary treatment. [Methods] Clinical data of 453 patients with FIGO stage Ⅲ,Ⅳ epithelial ovarian cancer who underwent primary resection in the Affiliated Women’s Hospital of Zhejiang University School of Medicine from January 2002 to December 2019 were retrospectively analyzed. The influencing factors of clinical outcomes were evaluated. [Results] Among 453 patients, 177 cases(39.1%) underwent R0 resection, and 358 cases(79.0%) achieved complete remission(CR). Univariate analysis showed that the operation time, ascites volume, FIGO stage, histological grade, histological subtype, serum CA125 level before treatment, number of chemotherapy cycles to achieve normal CA125 level, the total number of lymph node metastases, TP regimen chemotherapy were related to the initial treatment outcomes. Multivariate analysis showed that clear cell carcinoma(OR=0.043, 95%CI: 0.007~0.248), macroscopic residual tumor is larger(0~1 cm vs R0, OR=0.346, 95%CI: 0.153~0.784;≥1 cm vs R0, OR=0.269, 95%CI: 0.120~0.604), serum CA125 normalization required more chemotherapy cycles(3~4 vs 0~2, OR=0.413, 95%CI: 0.194~0.882;≥5 vs 0~2, OR=0.077, 95%CI: 0.035~0.169) were unfavorable factors in achieving CR;while G3(OR=2.677, 95%CI: 1.162~6.163) and TP regimen chemotherapy(OR=2.571, 95%CI: 1.170~5.651) were favorable factors to achieve CR. [Conclusion] For patients with clear cell carcinoma, attentions should be paid for those requiring more than 4 cycles of chemotherapy to achieve serum CA125 normalization, non-R0 surgery or non-TP chemotherapy. Early diagnosis, satisfactory tumor reduction, and timely adjustment of the treatment plan when the serum CA125 is not falling well can improve efficacy of primary treatment.
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