【作者】 张楠；

【导师】 张正茂；

【作者基本信息】 河北医科大学 ， 妇产科学（专业学位）， 2022， 硕士

【摘要】 目的:本研究的目的是通过对比分析晚期上皮性卵巢癌行肿瘤细胞减灭术后无肉眼残留病灶患者和可见肉眼残留病灶患者的临床病理特征、围术期情况及无疾病进展生存期、中位总生存期等临床数据,探讨残留病灶的大小对晚期上皮性卵巢癌患者生存结局的影响。方法:收集2012年1月至2021年10月就诊于河北医科大学第四医院并由同一术者行肿瘤细胞减灭术的晚期上皮性卵巢癌患共122例,其中术后无肉眼残留病灶的94例为R0组,可见肉眼残留病灶的的为28例为非R0组。所有患者均经术后石蜡病理检查确诊为卵巢癌,并采用国际妇产科联盟(International Federation of Gynecology and Obstetrics,FIGO)2013年分期标准重新进行手术-病理分期,均为ⅡB期～ⅣB期卵巢癌患者。收集上述患者的一般资料,并对其进行术后随访,回顾性分析两组的生存结局。应用SPSS R3.6.1版软件进行统计分析,经正态性检验后所取计量资料数据符合正态分布的采用x±s描述,不满足正态分布的采用中位数描述,计量资料的组间差异采用t检验或秩和检验进行分析;例数、百分率描述计数资料,采用?~2检验或Fisher确切概率法;采用survminer和survival包计算生存率并绘制生存曲线。以P<0.05为差异有统计学意义。结果:1.一般临床资料对比R0组中位年龄56岁;非R0组中位年龄62岁,差异无统计学意义(P>0.05),基础疾病、家族恶性肿瘤史、FIGO分期、病理类型及是否新辅助化疗均为无显著差异(P>0.05)。2.术中情况及术后住院时间比较R0组术中出血量505(300,800),术日输血率为93.6%及术日输血量1200.0(1200.0,1612.5);非R0组术中出血量480(342.5,655),术日输血率为85.7%及术日输血量1200(475,1520),差异均无统计学意义(P>0.05)。R0组术后住院时间为14(10,18),非R0组术后住院时间为12(10,16),差异无统计学意义(P>0.5)。3.两组患者术后并发症对比R0组术后发生相关并发症47例(50%),非R0组术后发生相关并发症6例(21.4%),差异有统计学意义(P<0.05)。4.生存情况比较4.1复发率R0组复发率为41.5%,94例中有39例患者复发;非R0组复发率为92.9%,28例中有26例患者复发。差异有统计学意义(P<0.05)4.2 PFS和OSR0组中位无进展生存期(PFS)41.7个月,非R0组患者中位无进展生存期(PFS)19.0个月,统计学分析两者差异有统计学意义(P=0.000,P<0.05)。R0组中位总生存期(OS)76个月,非R0组中位总生存期(OS)32.7个月,统计学分析两者差异有统计学意义(P=0.000,P<0.05)。4.3 1年、2年及3年生存率R0组1年生存率为98.7%,非R0组1年生存率为74.1%,P=0.000,P<0.05,差异有统计学意义。R0组2年生存率为87.9%,非R0组2年生存率为63%,P=0.007,P<0.05,差异有统计学意义。R0组3年生存率为72.5%,非R0组3年生存率为44.4%,P=0.015,P<0.05,差异有统计学意义。结论:1.与非R0组比较,R0组虽然增加了术后相关并发症,但其术中出血量、输血率及术后住院天数方面并未见明显差异。2.对于晚期上皮性卵巢癌的手术的彻底性至关重要,术后无肉眼残留病灶患者的PFS及OS相较于肉眼可见残留病灶患者有显著性差异。更多还原

【Abstract】 Objective: The purpose of this study was to compare and analyze the clinicopathological features,perioperative conditions,progression-free survival,and median overall survival of patients with advanced epithelial ovarian cancer who underwent cytoreductive surgery without macroscopic residual disease and those with visible macroscopic residual disease.Survival and other clinical data to explore the effect of residual disease size on survival outcomes in patients with advanced epithelial ovarian cancer.Methods: A total of 122 patients with advanced epithelial ovarian cancer who were treated in the Fourth Hospital of Hebei Medical University and underwent cytoreductive surgery by the same operator from January 2012 to October 2021 were collected.94 cases belonged to the R0 group,and 28 cases with visible residual lesions belonged to the non-R0 group.All patients were diagnosed with ovarian cancer by postoperative paraffin pathological examination,and underwent surgery-pathological staging according to the International Federation of Gynecology and Obstetrics(FIO)2013 staging criteria,all of which were stage IIB to IVB ovarian cancer patients.The general data of the above-mentioned patients were collected,followed up after surgery,and the survival outcomes of the two groups were retrospectively analyzed.SPSS R3.6.1 software was used for statistical analysis.After normality test,x± S description was used for measurement data conforming to normal distribution,median description was used for measurement data not conforming to normal distribution,and T test or rank-sum test was used to analyze inter-group differences of measurement data.2 test or Fisher’s exact probability method were used to describe the number of cases and percentage.Survminer and survival package were used to calculate survival rate and draw survival curve.P < 0.05 was considered as statistically significant difference.Results:1.Comparison of general clinical data:The median age of the R0 group was 56 years;the median age of the non-R0 group was 62 years,and the difference was not statistically significant(P>0.05).There were no significant differences in FIGO stage,pathological type and neoadjuvant chemotherapy(P>0.05).2.Comparison of intraoperative conditions and postoperative hospital staThe intraoperative blood loss in the R0 group was 505(300,800),the intraoperative blood transfusion rate was 93.6%,and the intraoperative blood transfusion volume was 1200.0(1200.0,1612.5);in the non-R0 group,the intraoperative blood loss was 480(342.5,655),and the intraoperative blood transfusion rate was 85.7% and the daily blood transfusion volume was 1200(475,1520),and the difference was not statistically significant(P>0.05).The postoperative hospital stay was 14(10,18)in the R0 group and 12(10,16)in the non-R0 group,with no significant difference(P>0.5).3.Comparison of postoperative complications between the two groups of patientRelated complications occurred in 47 cases(50%)in the R0 group and in6 cases(21.4%)in the non-R0 group,with a statistically significant difference(P<0.05).4.Comparison of Survival Conditions4.1 Recurrence ratThe recurrence rate in the R0 group was 41.5%,with 39 of 94 patients relapsed;the recurrence rate in the on-R0 group was 92.9%,with 26 of 28 patients relapsed.The difference was statistically significant(P<0.05).4.2 PFS and OSThe median progression-free survival(PFS)in the R0 group was 41.7months,and the median progression-free survival(PFS)in the non-R0 group was 19.0 months.The difference was statistically significant(P=0.000,P<0.05).The median overall survival(OS)of the R0 group was 76 months,and the median overall survival(OS)of the non-R0 group was 32.7 months.The difference was statistically significant(P=0.000,P<0.05).4.3 1-year,2-year,and 3-year survival ratesThe 1-year survival rate of the R0 group was 98.7%,and the 1-year survival rate of the non-R0 group was 74.1%,P=0.000,P<0.05,the difference was statistically significant.The 2-year survival rate of the R0 group was87.9%,and the 2-year survival rate of the non-R0 group was 63%,P=0.007,P<0.05,the difference was statistically significant.The 3-year survival rate of the R0 group was 72.5%,and the 3-year survival rate of the non-R0 group was44.4%,P=0.015,P<0.05,the difference was statistically significant.Conclusions:1.Compared with the non-R0 group,although the R0 group increased postoperative complications,there was no significant difference in the intraoperative blood loss,blood transfusion rate and postoperative hospital stay.2.The thoroughness of surgery for advanced epithelial ovarian cancer is crucial,and the PFS and OS of patients without macroscopic residual disease after surgery are significantly different from those of patients with macroscopic residual disease.更多还原