【作者】 孙琳；

【导师】 盛修贵；

【作者基本信息】 山东大学 ， 肿瘤学（专业学位）， 2019， 硕士

【摘要】 研究目的通过收集晚期原发性上皮性卵巢癌(AEOC)患者的临床病理资料进行回顾性研究,观察新辅助化疗后行间歇性肿瘤细胞减灭术和直接行初始肿瘤细胞减灭术在晚期原发性上皮性卵巢癌中的疗效,同时分析晚期上皮性卵巢癌患者的预后因素,为晚期上皮性卵巢癌的临床诊疗提供一定的参考.研究方法回顾性分析了2013年1月1日至2016年1月31日期间就诊于山东大学附属山东省肿瘤医院的420例AEOC患者的临床资料.探讨不同国际妇产科联盟(FIGO)分期、年龄、组织类型、组织分级、减瘤理想程度、化疗途径(腹腔灌注化疗IP和静脉化疗Ⅳ)、初始治疗的化疗周期数、治疗结束后CA125水平、复发后治疗方式(二次及多次减瘤联合化疗和单纯化疗)对生存的影响。同时观察新辅助化疗(NACT)组和初始肿瘤细胞减灭术(PDS)组的基本临床病理资料及减瘤理想程度、总生存(OS)及无进展生存期(PFS).研究结果患者的平均发病年龄为54.2岁;主要症状为腹胀,共215例,占59.0%;病理类型以浆液性为主,共361例,占96.4%;病理分级以G3(低分化)为主,共233例,占64.0%;FIGO分期以Ⅲ期为主,共296例,占81%.统计NACT组和PDS组的基本临床病理资料进行观察分析,发现两组间年龄,分期、病理类型及分级具有统计学差异。PDS组和NACT组总生存率分别为38.6%、44.9%,差异无统计学意义(P=0.772),无进展生存率分别为9.1%、16.8%,差异无统计学意义(P=0.367)。NACT组的减瘤理想率明显高于PDS组,差异有统计学意义(P<0.001)。单因素分析表明FIGO分期、年龄、减瘤理想程度、化疗途径、治疗后CA125水平、复发后的治疗方式与预后相关(均P<0.05);多因素分析表明FIGO分期、年龄、减瘤理想程度、治疗后CA125水平、复发后的治疗方式是影响AEOC患者总生存的独立预后因素(P<0.05)。研究结论1.通过观察发现两组病人基本临床病理资料存在一定的差异,其中NACT组的年龄明显高于PDS组;NACT组中Ⅳ期的病人明显多于PDS组;非浆液性多选择PDS;病理类型为中高分化的患者多行PDS,以上各因素分析均具有统计学差异。建议患者在治疗前认真评估减瘤所能达到的理想程度及围手术期的危险程度,若难以达理想减瘤及围手术期危险性高的患者推荐NACT。2.PDS组和NACT组OS和PFS无统计学差异,但是可以看出NACT组有提高OS和PFS的趋势。特别是提高PFS;对于提高Ⅳ期患者生存率的趋势更明显(34.8%:18.2%)。由此可见对于晚期上皮性卵巢癌患者来说,PDS和NACT两者都是可选择的治疗方式。值得注意的是因为不同病人及肿瘤的差异性,我们要根据不同情况选择出最佳的治疗方案,因此治疗前的评估尤为重要。3.NACT组的减瘤理想率明显高于PDS组,差异有统计学意义,且术后达到肉眼无瘤的患者明显高于PDS组。由此可见NACT能降低手术的难度,提高减瘤的理想程度。4.FIGO分期、年龄、减瘤理想程度、化疗途径、治疗后CA125水平、复发后的治疗方式与预后相关(均P<0.05)。其中FIGO分期、年龄、减瘤理想程度、治疗后CA125的水平、复发后的治疗方式是影响上皮性卵巢癌患者总生存期的独立预后因素(P<0.05)。更多还原

【Abstract】 ObjectiveA retrospective study was performed to collect clinical and pathological data from patients with advanced primary epithelial ovarian cancer(AEOC).To observe the efficacy of neoadjuvant chemotherapy followed by interval debulking surgery(NACT-IDS)and primary debulking surgery(PDS)in advanced epithelial ovarian cancer.Simultaneous analysis of prognostic factors in patients with advanced epithelial ovarian cancer,provide a reference for the clinical diagnosis and treatment of advanced epithelial ovarian cancer.MethodsThe clinical data of 420 patients with AEOC who were admitted to the Shandong Cancer Hospital affiliated to Shandong University from January 1,2013 to January 31,2016 were retrospectively analyzed.To explore the different international obstetrics and gynecology alliance(FIGO)staging,age,tissue type,tissue grading,ideal degree of cytoreductive,chemotherapy route(intraperitoneal chemotherapy IP and intravenous chemotherapy IV),initial treatment chemotherapy cycle,CA125 level after treatment The effect of treatment after relapse(second and multiple cytoreduction combined with chemotherapy and only chemotherapy)on survival.At the same time,the basic clinical and pathological data,the ideal degree of tumor reduction,the overall survival(OS)and the progression-free survival(PFS)of neoadjuvant chemotherapy(NACT)group and primary debulking surgery(PDS)group were observed.ResultsThe average age of patient was 54.2 years old;the main symptoms were abdominal distension,a total of 215 cases,accounting for 59.0%;the pathological type was mainly serous,a total of 361 cases,accounting for 96.4%;pathological grade was mainly G3(low differentiation),a total of 233 cases,accounting for 64.0%;FIGO stage was mainly in stage III,a total of 296 cases,accounting for 81%.The basic clinical and pathological data of NACT group and PDS group were analyzed.It was found that there were statistical differences in age,stage,pathological type and grade between the two groups.The overall survival rates of the PDS group and the NACT group were 38.6%and 44.9%,respectively,and the difference was not statistically significant(P=0.772),The progression-free survival rates were 9.1%and 16.8%,respectively,and the difference was not statistically significant(P=0.367).The ideal rate of tumor reduction in the NACT group was significantly higher than that in the PDS group,and the difference was statistically significant(P<0.001).Univariate analysis showed that FIGO stage,age,ideal degree of tumor reduction,chemotherapy route,amount of CA125 after treatment,and treatment after recurrence were correlated with prognosis(P<0.05).Multivariate analysis showed that FIGO stage,age,and ideal degree of tumor reduction,the amount of CA125 after treatment,and the treatment mode after recurrence were independent prognostic factors affecting the overall survival of patients with epithelial ovarian cancer(P<0.05).Conclusions1.By observing the basic clinical pathological data,it was found that there were some differences in the choice of patients in the NACT group and the PDS group.The age of NACT group was significantly higher than that of PDS group;the number of patients in stage IV of NACT group was significantly higher than that of PDS group;non-serous multiple choice PDS;pathological type of patients with moderately and highly differentiated PDS,all the above factors were statistically significant.difference.Patients are advised to carefully assess the ideal degree of neutropenia and the risk of perioperative period before treatment.If it is difficult to achieve ideal cytoreductive and perioperative risk,recommend NACT.2.There was no statistical difference between OS and PFS in PDS group and NACT group,but it can be seen that NACT group has a tendency to improve OS and PFS.In particular,the PFS was improved;the trend of improving the survival rate of patients in stage IV was more obvious(34.8%:18.2%).It can be seen that both PDS and NACT are alternative treatments for patients with advanced epithelial ovarian cancer.It is worth noting that because of the differences in different patients and tumors,we have to choose the best treatment according to different situations,so the pre-treatment evaluation is especially important.3.The ideal rate of tumor reduction in the NACT group was significantly higher than that in the PDS group.The difference was statistically significant,and the number of patients with no tumor after surgery was significantly higher than that of the PDS group.It can be seen that NACT can reduce the difficulty of surgery and improve the ideal degree of tumor reduction.4.FIGO stage,age,ideal degree of tumor reduction,chemotherapy route,CA125 level after treatment,and treatment after recurrence were associated with prognosis(all P<0.05).Among them,FIGO stage,age,ideal degree of tumor reduction,level of CA125 after treatment,and treatment after recurrence were independent prognostic factors affecting the overall survival of patients with epithelial ovarian cancer(P<0.05).更多还原