CAJ | 학술논문

目的评估复发性上皮性卵巢癌的临床特点,探讨影响首次治疗后无瘤生存时间以及复发后治疗效果的因素.方法回顾54例复发性上皮性卵巢癌患者的病历资料,分析患者的临床分期、组织学类型、初次治疗手段、无瘤生存期、复发部位、复发后治疗及疗效,并进行统计学分析.结果 54例患者中,中位无瘤生存时间(DFI)19.07个月(7～76个月).分析表明,首次治疗手术达到满意减瘤效果的患者的DFI明显长于未满意减瘤的患者[(32±19.10)个月vs (18.77±7.80)个月,P ＜0.01];病理类型为浆液性、黏液性、透明细胞型的患者的DFI分别为[(20.16±14.63)个月、(14.00±4.73)个月及(16.67±13.03)个月],提示黏液性腺癌的患者的DFI最短;组织学类型为中高分化的患者的DFI明显长于低分化的患者[(28.18±16.97)个月vs(16.52±9.46)个月];临床分期为Ⅰ～Ⅱ期、Ⅲ期、Ⅳ期患者的DFI分别为(19.60±12.89)个月、(19.22±12.38)个月及(11.67±5.39)个月,提示分期越晚,患者的DFI越短.复发后最常见的转移部位位于盆腔(50％),其次是上腹部(29.6％)及淋巴结(29.6％),其中复发的淋巴结最常见的部位位于腹膜后(24.1％).DFI为6～ 12个月及＞12个月的患者,经复发治疗3个月后,治疗效果差异无统计学意义(P＞0.05),这可能与样本量较小有关.结论首次治疗达到满意减瘤、肿瘤分化程度较高的患者、分期早的患者的DFI较长,其中术后残余灶的大小应该是影响DFI的最为重要的因素.部分晚期患者,在首次手术时,可考虑腹膜后淋巴结的切除,以减少术后的复发.
목적 평고복발성상피성란소암적림상특점,탐토영향수차치료후무류생존시간이급복발후치료효과적인소.방법 회고54례복발성상피성란소암환자적병력자료,분석환자적림상분기、조직학류형、초차치료수단、무류생존기、복발부위、복발후치료급료효,병진행통계학분석.결과 54례환자중,중위무류생존시간(DFI)19.07개월(7～76개월).분석표명,수차치료수술체도만의감류효과적환자적DFI명현장우미만의감류적환자[(32±19.10)개월vs (18.77±7.80)개월,P ＜0.01];병리류형위장액성、점액성、투명세포형적환자적DFI분별위[(20.16±14.63)개월、(14.00±4.73)개월급(16.67±13.03)개월],제시점액성선암적환자적DFI최단;조직학류형위중고분화적환자적DFI명현장우저분화적환자[(28.18±16.97)개월vs(16.52±9.46)개월];림상분기위Ⅰ～Ⅱ기、Ⅲ기、Ⅳ기환자적DFI분별위(19.60±12.89)개월、(19.22±12.38)개월급(11.67±5.39)개월,제시분기월만,환자적DFI월단.복발후최상견적전이부위위우분강(50％),기차시상복부(29.6％)급림파결(29.6％),기중복발적림파결최상견적부위위우복막후(24.1％).DFI위6～ 12개월급＞12개월적환자,경복발치료3개월후,치료효과차이무통계학의의(P＞0.05),저가능여양본량교소유관.결론 수차치료체도만의감류、종류분화정도교고적환자、분기조적환자적DFI교장,기중술후잔여조적대소응해시영향DFI적최위중요적인소.부분만기환자,재수차수술시,가고필복막후림파결적절제,이감소술후적복발.
Objective To investigate the clinical features of patients with recurrent epithelial ovarian cancer (EOC),and explore the factors that can prolong the disease-free interval(DFI) after primary treatment.Methods We retrospectively reviewed the medical records of 54 patients with recurrent EOC and analyzed the clinical stage,histological subtypes,primary treatments,DFI,recurrent site,secondary treatment,and the response after secondary treatment.By Mann-Whitney test and T test,factors influent the DFI were analyzed,the relationship between DFI and the response after secondary treatment were analyzed also.Results The mean DFI for all 54 patients was 19.07 months.The DFI of patients received optimal cytoreductive surgery was longer than those received non-optimal cytoreductive surgery [(32 ± 19.10) months vs (18.77 ± 7.80) months,P ＜ 0.01];The DFI of patients with serous,mucous and clear cell tumor was [(20.16 ± 14.63) months,(14.00 ± 4.73) months and (16.67 ± 13.03) months,respectively],suggesting patients with mucous tumor might have shorter DFI.The DFI of patients with low tumor grade was longer than those with high tumor grade [(28.18 ± 16.97) months vs (16.52 ±9.46) months,respectively];The DFI of patients with stage Ⅰ and Ⅱ disease was [(19.60 ± 12.89)months],was compared to the DFI of patients with stage Ⅲ,stage Ⅳ disease,which was [(19.22 ± 12.38) months] and [(11.67 ±5.39) months],respectively.When disease recurred,the most frequent recurrent site was pelvic (50％,n =27),with upper abdominal (29.6％) and lymph node(29.6％) followed.When recurrence was found in lymph node,the most frequent site was pelvic and para-arotic lymph node.In our study,when disease recurred,response of the tumor after the secondary treatment has no relationship with the DFI.Conclusions Patients received optimal cytoreductive surgery,patients with low tumor grade and early stage have longer DFI.Retroperitoneal lymphadenectomy might be chosen during the primary cytoreductive surgery in some selected patients.