2种不同疗法对晚期上皮性卵巢癌的疗效及患者预后影响因素分析

doi:10.3969/j.issn.1004-616x.2023.02.009

摘要/Abstract

摘要： 目的：对比新辅助化疗-间歇性肿瘤细胞减灭术(NACT-IDS)与初始肿瘤细胞减灭术(PDS)治疗晚期上皮性卵巢癌的疗效，并分析影响晚期上皮性卵巢癌患者预后的因素。方法：收集2010年1月—2019年12月在汕头大学医学院附属肿瘤医院初治的晚期上皮性卵巢癌患者病例资料106例，根据治疗方式分为NACT-IDS(67例)与PDS(39例)组，其中NACT-IDS组根据术前化疗周期分为 2 个亚组，即新辅助化疗≤2 疗程组(NACT-IDS-1，40 例)与新辅助化疗>2 疗程组(NACT-IDS-2，27 例)。采用生存分析对比NACT-IDS与PDS及NACT-IDS两个亚组组间总生存期(OS)与无进展生存期(PFS)的差异，统计分析术中出血量、手术时间与术后并发症等的差异，采用COX比例风险模型分析临床病理等因素与预后的关系。结果：106例患者中，58例(54.7%)患者死亡，中位随访时间为 46 个月，NACT-IDS 组和 PDS 组中位 OS 分别为 44 个月和 42 个月，两组中位 PFS 均为 21 个月；NACT-IDS 两亚组中，NACT-IDS-1 组与 NACT-IDS-2 组的中位 OS 均为 44 个月，中位 PFS 分别为 20 个月和 25 个月，NACT-IDS 组和 PDS 组间以及NACT-IDS两亚组间中位OS与中位PFS差异均无统计学意义(均P>0.05)。与PDS组相比，NACT-IDS组在术中出血量、手术时间、术后并发症的发病率及术后开始化疗的时间均降低，差异均有统计学意义(均P<0.05)。多因素COX比例风险模型结果显示，残存病灶与无残存病灶比较，对OS影响的差异具有统计学意义[HR=2.82，95%CI(1.20，6.63)，P=0.017]；术后化疗4周期CA-125恢复正常与未恢复正常者比较，对OS与PFS影响的差异均具有统计学意义[HR=0.39，95%CI(0.18，0.88)，P=0.022；HR=0.34，95%CI(0.17，0.71)，P=0.004]。结论：NACT-IDS较PDS治疗晚期上皮性卵巢癌，能提高手术质量，但对总生存获益无显著提升，建议条件允许下尽早行IDS。残存病灶和术后化疗4周期CA-125恢复程度是影响晚期上皮性卵巢癌OS的独立预后因素。

关键词: 晚期上皮性卵巢癌, 间歇性肿瘤细胞减灭术, 初始肿瘤细胞减灭术, 预后

Abstract: OBJECTIVE： To compare the efficacy of neoadjuvant chemotherapy followed by interval debulking surgery with primary debulking surgery for advanced epithelial ovarian cancer，and to analyze the influencing factors of the prognosis. METHODS：From January 2010 to December 2019，advanced epithelial ovarian cancer patients (FIGO stage Ⅲ or Ⅳ) who were initially treated at the Department of Cancer Hospital of Shantou University Medical College，106 were selected and divided into two treatment groups：neoadjuvant chemotherapy with interval debulking surgery (NACT-IDS) and primary debulking surgery (PDS). Among the NACT-IDS group，patients were divided into 2 subgroups according to the preoperative chemotherapy cycles： the neoadjuvant chemotherapy ≤2 cycles (NACT-IDS-1) group and the neoadjuvant chemotherapy >2 cycles (NACT-IDS-2) group. Our patients were included into 67 cases in the NACT-IDS group (40 cases in the NACT-IDS-1 group，and 27 cases in the NACT-IDS-2 group) and 39 cases in the PDS group. Information about the general pathological characteristics， intraoperative bleeding， postoperative outcomes， and survival outcomes of the patients were analyzed retrospectively. Survival analysis was used to compare differences in overall survival (OS) and progression-free survival (PFS) between the groups of NACT-IDS and PDS and the two subgroups of NACT-IDS. T-test，chi-square test and Fisher's exact test were used to compare differences in intraoperative bleeding，operative time，and postoperative complications，etc. The Cox proportional hazards model was used to analyze relationships between clinicopathological characteristics and surgery-related characteristics with prognosis. RESULTS：Among the 106 patients，58 (54.7%) died and the median follow-up time was 46 months. The median OS was 44 and 42 months in the NACT-IDS and PDS groups，respectively， and the median PFS was 21 months in both groups. The differences in median OS and median PFS between the NACT-IDS and PDS groups and between the NACT-IDS subgroups were not statistically significant (all P>0.05). Compared with the PDS group， the NACT-IDS group showed significant differences in intraoperative bleeding，operative time，incidence of postoperative complications，and time to start chemotherapy after surgery (all P<0.05). The results of the multivariable COX proportional hazards model showed that residual disease (incomplete resection) versus no residual disease (complete resection) was statistically significant on OS [HR= 2.82， 95% CI(1.20， 6.63)， P=0.017]； the effect of normalization of CA-125 after 4 cycles of postoperative chemotherapy was statistically significant on both OS and PFS compared with those who did not [HR=0.39， 95%CI(0.18，0.88)，P=0.022；HR=0.34，95%CI(0.17，0.71)，P=0.004]. CONCLUSION：NACT-IDS improves the quality of surgery compared with PDS for advanced epithelial ovarian cancer，but does not significantly enhance the overall survival benefit，and suggests early IDS as soon as conditions permit. Residual disease and whether CA-125 recovered to normal after 4 cycles of postchemotherapy were independent prognostic factors affecting OS in advanced epithelial ovarian cancers.

Key words: advanced epithelial ovarian cancer, interval debulking surgery, primary debulking surgery, prognosis

中图分类号:

R737.31

谭健华, 赖姚圳, 唐丽华, 周莉. 2种不同疗法对晚期上皮性卵巢癌的疗效及患者预后影响因素分析[J]. 癌变·畸变·突变, 2023, 35(2): 131-138.

TAN Jianhua, LAI Yaozhen, TANG Lihua, ZHOU Li. Efficacy and prognostic values of two treatments for advanced epithelial ovarian cancers[J]. Carcinogenesis, Teratogenesis & Mutagenesis, 2023, 35(2): 131-138.

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