CAJ | 학술논문

目的：分析复发性卵巢癌的临床特点及两种治疗方法对预后的影响，探讨能延长卵巢癌初次治疗后临床缓解时间（DFI）的因素，为复发性卵巢癌选择适宜的治疗方案。方法回顾性分析有完整临床资料的复发性卵巢癌患者54例。具体分析DFI和总生存时间与病理类型、分期、残留灶、化疗疗程的关系；并比较卵巢癌复发后采取两种治疗方法对再次缓解率和复发后的生存时间的影响。结果在39例死亡病例中，初次治疗后DFI越长，患者生存时间也越长，两者之间存在正相关（r=0.65，P＜0.05）。对54例患者DFI进行多因素分析显示，不同的病理类型患者的DFI不同，差异有统计学意义（F=6.22，P＜0.05），其中浆液性癌与子宫内膜样癌的DFI比较，差异无统计学意义（q=0.52，P＞0.05），而腺癌的DFI较前两者短，差异均有统计学意义（q分别=0.03、0.01，P均＜0.05）；临床手术分期越早，残留灶≤2 cm、化疗疗程正规将明显延长DFI，差异均有统计学意义（t分别=2.29、2.99、2.24，P均＜0.05）。复发癌行二次肿瘤细胞减灭术+补救化疗患者，再次缓解率和复发后2年、3年生存率明显高于单纯补救化疗患者，差异均有统计学意义（χ2分别=16.27、11.20、11.84，P均＜0.05），而1年、4年、5年生存率差异均无统计学意义（χ2分别=5.59、6.42、4.38，P均＞0.05）。结论影响卵巢癌患者DFI的因素有病理类型、手术分期、残留灶大小及术后化疗疗程。再次手术联合化疗可提高复发性卵巢癌患者近期的生存率，但不能明显改善患者的生存时间。
목적：분석복발성란소암적림상특점급량충치료방법대예후적영향，탐토능연장란소암초차치료후림상완해시간（DFI）적인소，위복발성란소암선택괄의적치료방안。방법회고성분석유완정림상자료적복발성란소암환자54례。구체분석DFI화총생존시간여병리류형、분기、잔류조、화료료정적관계；병비교란소암복발후채취량충치료방법대재차완해솔화복발후적생존시간적영향。결과재39례사망병례중，초차치료후DFI월장，환자생존시간야월장，량자지간존재정상관（r=0.65，P＜0.05）。대54례환자DFI진행다인소분석현시，불동적병리류형환자적DFI불동，차이유통계학의의（F=6.22，P＜0.05），기중장액성암여자궁내막양암적DFI비교，차이무통계학의의（q=0.52，P＞0.05），이선암적DFI교전량자단，차이균유통계학의의（q분별=0.03、0.01，P균＜0.05）；림상수술분기월조，잔류조≤2 cm、화료료정정규장명현연장DFI，차이균유통계학의의（t분별=2.29、2.99、2.24，P균＜0.05）。복발암행이차종류세포감멸술+보구화료환자，재차완해솔화복발후2년、3년생존솔명현고우단순보구화료환자，차이균유통계학의의（χ2분별=16.27、11.20、11.84，P균＜0.05），이1년、4년、5년생존솔차이균무통계학의의（χ2분별=5.59、6.42、4.38，P균＞0.05）。결론영향란소암환자DFI적인소유병리류형、수술분기、잔류조대소급술후화료료정。재차수술연합화료가제고복발성란소암환자근기적생존솔，단불능명현개선환자적생존시간。
Objective To investigate the clinical features of recurrent ovarian carcinoma and the effects of two different treatments on prognosis and explore the factors that can prolong the disease-free interval(DFI). Methods Fifty-four cases of recurrent ovarian carcinoma with completed clinical therapy data were collected and retrospectively reviewed. The rela-tionship between DFI and total survival time, possible factors including pathologic type, clinical stage, residual mass, and chemotherapy course were analyzed. The re-remission rate and survival time between different treatments of recurrent ovar-ian carcinoma were compared. Results In 39 death cases, the longer the DFI after initial treatment, the longer the pa-tients' survival time, there was a positive correlation between them (r=0.65, P<0.05). The DFI of different pathological types of ovarian carcinoma were different(F=6.22,P<0.05).There was no significant difference of DFI between serous car-cinoma and endometrial carcinoma (q=0.52,P>0.05). Compared with serous carcinoma and endometrial carcinoma, the DFI of adenocarcinoma was significantly shorter (q=0.03,0.01,P<0.05).Early staging, small residual mass and standard-ized chemotherapy courses could prolong DFI (t=2.29,2.99,2.24,P<0.05). Compared with remedial chemotherapy, pa-tients underwent secondary cytoreductive surgery followed with remedial chemotherapy had higher re-remission rate (χ2=16.27,P<0.05).There were a significant differences in 2 and 3 years survival rates between the patients received two types of therapy (χ2=11.20,11.84,P<0.05)while there were no significant differences in 1, 4 and 5 years survival rates (χ2=5.59,6.42,4.38,P>0.05). Conclusions Pathologic type, clinical stage, residual mass and chemotherapy course have some effects on the DFI. Secondary cytoreductive surgery with chemotherapy can improve the short-term survival rate of recurrent ovarian carcinoma, but it can not prolong the patients'survival time.