【摘要】 目的　探讨老年晚期卵巢上皮癌 (AEOC)患者肿瘤细胞减灭术和化疗的疗效。　方法　回顾分析了 1986～ 1997年我院治疗的年龄≥ 70岁及以上的AEOC患者 2 8例 (老年组 ) ,同期 32 0例非老年 (年龄 <70岁 )AEOC患者为对照。Log rank检验生存率差异 ,Cox逐步回归模型分析预后影响因素。　结果　老年组中位生存时间 17个月 ,对照组为 2 4个月 ;老年组 3年和 5年生存率分别为 2 6 7%和 2 6 7% ,对照组为 35 7%和 17 7% ,两组比较差异无显著性 (P >0 0 5 )。老年组残癌1cm和 >1cm的中位生存期分别为 6 1、12个月 ,差异有显著性 (χ2 =16 6 0 ,P <0 0 0 1) ;有、无腹腔化疗的中位生存期分别为 2 7、12个月 (χ2 =3 4 5 ,P =0 0 6 33)。考虑年龄因素的多因素分析结果显示 ,残癌大小、分期、复发性腹水、子宫肌层肿瘤累及等 4个因素和预后有关。　结论　老年AEOC患者与非老年AEOC患者生存期无显著的差异 ,不应该放弃积极的治疗。满意的肿瘤细胞减灭术是最主要的治疗手段 ,化疗应因人而异 ,不强调足够疗程的全身化疗。腹腔化疗有一定的治疗价值 ,应进一步探讨。更多还原

【Abstract】 Objective To investigate the role of cytoreductive surgery and chemotherapy for elderly Chinese women with advanced epithelial ovarian cancer (AEOC). Methods Twenty-eight patients diagnosed as AEOC at the age ≥ 70 years from 1986 to 1997 were retrospectively reviewed, with other 320 women with AEOC at the age<70 years at the same period as control. Survival was calculated by Kaplan-Meier method with difference in survival estimated by Log-rank test. Independent prognostic factors were identified by the COX’s stepwise regression model, and variants associated with disease recurrence were found by Logistic stepwise regression methods. Results The median age was 74 (ranged 70-82) years. There was no significant statistical difference in survival between elderly and non-elderly AEOC women with the median survival time of 17 and 24 months; 3-year survival of 26.7% and 35.7%; 5-year survival of 26.7% and 17.7%, respectively ( P >0.05). When elderly AEOC patients with residual cancer ≤ 1cm in size after surgical cytoreduction were compared to those with >1cm, there was a significant statistical difference in median survival of 61 and 12 months, respectively (χ 2 =16.60, P =0.0001). The median survival for patients with and without peritoneal chemotherapy were 27 and 12 months, respectively (χ 2 =3.45, P =0.0633). Residual disease, FIGO stage, recurrent ascites, uterus muscle involvement were independent prognostic determinants of survival identified by Cox’s stepwise regression analysis. Conclusions Aggressive surgical cytoreduction should be performed in elderly AEOC patients as well as in younger patients, but multi-course platinum-based chemotherapy should be used in accordance with the performance status of elder women.更多还原